Clinton’s sixth nerve palsy: What difference does it make?

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These days, I focus more on what comes out of Hillary Clinton’s mouth, than on how her eyes move. And I love to watch how individuals’ eyes move.

I have not scrutinized Clinton’s extensive medical record, but here’s what I do know. In January of 2013, Secretary of State Clinton appeared before Congress with thick glasses.

{mosads}These were more stylish spectacles than she used to wear as a student at Wellesley.

Clinton was testifying on the Benghazi debacle. The left lens of Hillary’s glasses appeared hazy and a close-up of her black frames revealed a sticker with vertical lines. That sticker is commonly used to manage diplopia or double vision.

Without getting into an optics lesson, a prism changes the direction of light as it hits the eye and limits double vision. One can glean that at these hearings, Clinton is almost certainly suffering from some type of double vision, a surprisingly common problem — especially in my clinic. This can be not only annoying, but also debilitating. Many of my patients may patch an eye for some time while awaiting a more permanent solution.

Double vision is usually the result of a misaligned eye. I often explain to my patients that eyes must line up like the wheels of a car. If one wheel of a car is out of alignment, the stability of the car is adversely affected and the car may drift.

While your mom or grandfather’s automobile may drift because they rolled the curb pulling into Applebee’s, eyes can be knocked out of alignment for hundreds of reasons, such as small strokes, thyroid problems, high blood sugar or blood pressure. Eye misalignment is called strabismus, which is a Greek word meaning “to squint.” Eyes can drift in, out, up or down.

While strabismus is usually thought of as a pediatric problem, the field of adult eye muscles disease has grown in recent years. It is almost always what I call fixable.

The problem will either improve on its own, the patient may require permanent prism therapy, or a short surgical procedure to realign the eyes — kind of like a trip to Firestone gets the tires aligned. Eye muscles can be tightened or loosened to help realign the eyes.

Now let’s get back to Hillary. Around the time of those Benghazi hearings in early 2013, Clinton reportedly took a tumble and suffered some type of head trauma.

Word circulated on ophthalmology bulletin boards that Clinton indeed was sporting a Fresnel Prism over her glasses. She became the focus of many frantic emails in the eye community. I would surmise from looking at the direction of the lines on Hillary’s glasses, that Clinton developed a sixth cranial nerve paralysis or palsy as the result of her fall.

Let me explain why a sixth nerve palsy can be so debilitating. Nerves that originate in the brain or spinal column activate muscles in our body and cause those muscles to move. The same is true for the eye.

The sixth nerve functions to allow the lateral rectus muscle to abduct the eye or pull the eye outward. If this muscle is weak or knocked out, the eye will cross in towards the nose and the patient will suffer severe side-by-side double vision of varying degrees.

I see this problem several times a week. While frustrating, it will generally resolve over 3-4 months. If it resolves on its own or is surgically corrected, a sixth nerve palsy is unlikely to return.

Reports have come to light that Hillary had a dural venous sinus thrombosis, a treatable blood clot in one of the outflow tracts of the brain and another potential cause of a sixth nerve palsy. As far as nerves go, the sixth cranial nerve is quite long and prone to stretching or damage.

That damage will cause double vision and this is likely why Clinton was wearing the Fresnel prism.

Now, I’ll be first in line to attack Hillary’s tax or health care plans. I’ll save that for next week’s column if I’m invited back. But as for Clinton’s sixth nerve palsy, what difference does it make?

Zev Shulkin, M.D. is an ophthalmologist in Dallas, Texas in private practice. He specializes in ophthalmic plastic surgery, pediatric ophthalmology and adult strabismus, and neuro-ophthalmology.


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