Isolated bilateral abducens nerve palsy is a condition characterized by simultaneous damage to both abducens nerves without involvement of other cranial nerves, with clinical manifestations primarily featuring double vision and limited outward movement of both eyes. Previous literature mainly consists of case reports, involving complex and varying etiologies and pathological mechanisms. This article focuses on isolated bilateral abducens nerve palsy, analyzing the causes, pathological mechanisms, and differential diagnosis based on domestic and international literature reports on bilateral abducens nerve palsy over the past decade. The etiologies are categorized into three major types: secondary, congenital, and idiopathic. Pathological mechanisms include excessive traction, direct compression, blood-neurotoxic substances, nutritional deficiencies, and vascular supply disorders. The aim is to provide insights for the etiological research and clinical diagnosis and treatment of bilateral abducens nerve palsy.