Solitary abducens palsy secondary to isolated sphenoid sinus disease (ISSD) is rare and early management is important. There is no report regarding the results of endoscopic sinus surgery (ESS) for prolonged abducens palsy due to ISSD. We present four cases of ISSD with solitary abducens palsy that received ESS from 1995 through 2000. The interval between onset of diplopia and ESS was longer than 96 hours (range, 4 days to 42 months). The sphenoid lesions were caused by Aspergillosis in two patients and inflammation in two. Three patients recovered completely from abducens palsy after 4-17 months and had no surgical complications. In conclusion, ESS is a safe and effective treatment for ISSD with abducens palsy. Recovery from abducens palsy is slow and progressive. Improvement of extraocular movement is an early sign of recovery.