Objective To evaluate the efficacy and safety of botulinum toxin injections combined with or without sodium hyaluronate in the absence of electromyography for the treatment of traumatic sixth nerve palsy. Methods In this prospective， comparative， interventional case series， 27 patients with traumatic sixth nerve palsy who was older than 16 years old and presented within 6 months of trauma were randomly divided into 2 groups by drawing lots. In group A， 13 cases were treated with an injection of 2.5-7.5 U BTA combined with sodium hyaluronate in the antagonist medial rectus muscle. In group B， 14 cases were treated with an injection of 2.5-7.5 U BTA solution alone in the antagonist medial rectus muscle. Electromyography was not used in the study. All patients were evaluated preoperatively and 2 weeks and 6 months following the injections. Data were analyzed using paired t test， independent t test and chi-square test. Results The size of deviation was significantly reduced 2 weeks following the injections in both groups （t=8.75， P＜0.01 in group A， t=8.79， P＜0.01 in group B）. The recovery rate in groups A and B were 62% and 71% respectively， which had no statistical significance （χ2=0.297， P>0.05）. No ptosis or vertical deivation was encountered in both groups. Conclusion BTA injections combined with or without sodium hyaluronate in the absence of electromyography demonstrated effectiveness and safety in the treatment of traumatic sixth nerve palsy.