Here, we report a child who presented with an isolated left sixth cranial nerve palsy as the initial sign of anti-myelin oligodendrocyte glycoprotein antibody associated disease (MOGAD).<h4>Method</h4>In this case study, we report on a three-year-old female known to the orthoptic and paediatric ophthalmology services due to an intermittent exotropia. Here, OMG is linked to abducens nerve palsy.