Ophthalmoparesis

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List of terms related to Ophthalmoparesis

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Ophthalmoparesis is a physical finding in certain neurologic illnesses. It refers to paralysis of the extraocular muscles which are responsible for eye movements. It can refer to complete paralysis of the eyes, in which case it is synonymous with ophthalmoplegia. More usually, it refers to a partial paralysis, in contrast to the complete paralysis denoted by ophthalmoplegia.

Classification

Ophthalmoparesis can involve any or all of the extraocular muscles, which include the superior recti, inferior recti, medial recti, lateral recti, inferior oblique and superior oblique muscles.

It can also be classified by the directions of affected movements, e.g. "vertical ophthalmoparesis".

Types of ophthalmoplegia are:

• Progressive external ophthalmoplegia
• Supranuclear ophthalmoplegia

Causes

Ophthalmoparesis can result from disorders of various parts of the eye and nervous system:

• The orbit of the eye, including mechanical restrictions of eye movement, as in Graves disease.
• The muscle, as in progressive external ophthalmoplegia or Kearns-Sayre syndrome
• The neuromuscular junction, as in myasthenia gravis.
• The cranial nerves or their brainstem nuclei of the oculomotor, trochlear, and abducens.
• White matter tracts in the brainstem, as in internuclear ophthalmoplegia, an occasional finding in multiple sclerosis.
• Injury to supranuclear structures, as in progressive supranuclear palsy.
• Very rarely, disorders of higher brain structures, including the parietal lobes of the cerebral cortex.

Thiamine deficiency can cause ophthalmoparesis in susceptible persons; this is part of the syndrome called Wernicke encephalopathy. The causal pathway by which this occurs is unknown. Intoxication with certain substances, such as phenytoin, can also cause ophthalmoparesis.

Common Causes

• List the most common causes here.

Causes by Organ System

Cardiovascular	Carotid artery dissection, Carotid-cavernous fistula, Coarctation of aorta, Hypertension, Ischemia
Chemical/Poisoning	Amnesic shellfish poisoning, Aralytic shellfish poisoning , Atractaspididae (african mole viper), Carbamates, Ciguatera poisoning, Cobra poisoning , Colubridae (boomslang, twig snake), Crotoxin (Rattlesnake), Elapidae, Eurotoxic shellfish poisoning, Kraits, Mamba snake, Notexin (tiger snake), Organophosphates, Scombroid poisoning, Taipoxin (taipan), Viperidae -bungarotoxin
Dental	No underlying causes
Dermatologic	No underlying causes
Drug Side Effect	Aminoglycoside , Atorvastatin, Beta blockers, Carbamates, Carbamazepine, D-penicillamine, Fluoroquinolone , Fluvastatin, Glucocorticoids, Gold, Lithium, Lovastatin, Organophosphates, Phenytoin , Pitavastatin, Pravastatin, Pregabalin, Simvastatin, Vincristine
Ear Nose Throat	Acute bacterial rhinosinusitis, Arias oculootoradial syndrome, Gradenigo-lannois syndrome, Nasopharyngeal carcinoma, Neck masses, Otitis media, Wildervanck syndrome
Endocrine	Diabetes mellitus, Graves' disease, Growth hormone secreting pituitary adenoma
Environmental	Alcoholism, Amnesic shellfish poisoning, Aralytic shellfish poisoning , Atractaspididae (african mole viper), Botulism, Carbamates, Ciguatera poisoning, Cobra poisoning , Colubridae (boomslang, twig snake), Crotoxin (brazilian rattle snake), Elapidae, Eurotoxic shellfish poisoning, Gold, Kraits, Mamba snake, Notexin (tiger snake), Organophosphates, Scombroid poisoning, Taipoxin (taipan), Thiamine deficiency, Tick paralysis, Toscana virus, Viperidae beta-bungarotoxin (krait), Wernicke-korsakoff syndrome
Gastroenterologic	Inflammatory bowel disease, Myoneurogastrointestinal encephalopathy syndrome, Whipple's disease,
Genetic	Aarskog syndrome, Agenesis of extraocular muscles, Angelman-like syndrome, Athabaskan brain stem dysgenesis, Autosomal-dominant progressive external opthalmoplegia (adPEO), Central core myopathy, Centronuclear myopathy, Christianson type x-linked mental retardation, Congenital fiber-type disproportion myopathy, Congenital fibrosis of extraocular muscles(FEOM), Diabetes mellitus, Duane ocular retraction syndrome, Ehlers danlos syndrome, Familial horizontal gaze palsy with progressive scoliosis, Fatty acid hydroxylase-associated neurodegeneration, Friedreich ataxia, Infantile-onset spinocerebellar ataxia, Kearns-sayre syndrome, Kufor-rakeb syndrome, Lambert-eaton myasthenic syndrome, Levic-stefanovic-nikolic syndrome , Limb-girdle muscular dystrophy , MELAS syndrome, Niemann-pick disease, Oculopharyngeal muscular dystrophy, Polycystic kidney disease , Vertebrobasilar insufficiency
Hematologic	No underlying causes
Iatrogenic	Amnesic shellfish poisoning, Aralytic shellfish poisoning , Atractaspididae (african mole viper), Brain injury, Ciguatera poisoning, Cobra poisoning , Colubridae (boomslang, twig snake), Crotoxin (brazilian rattle snake), Eurotoxic shellfish poisoning, Eye Packing, Gold, Guillain-barre syndrome , Kraits, Lumbar epidural anesthesia , Magnesium sulfate, Mamba snake, Notexin (tiger snake), Raised intracranial pressure, Scombroid poisoning, Taipoxin (taipan), Tick paralysis, Viperidae beta-bungarotoxin (krait)
Infectious Disease	Acute bacterial rhinosinusitis, Acute disseminated encephalomyelitis, Aspergillus sp, Bacterial conjunctivitis, Blepharitis, Botulism, Brain abscess, Episcleritis, Fungal conjunctivitis, Infection , Inflamed pterygium, Optic neuritis, Otitis media, Periorbital cellulitis, Preseptal cellulitis, Quaternary syphilis, Rabies, Rhino-orbital-cerebral mucormycosis , Scleritis, Toscana virus, Tuberculosis
Musculoskeletal/Orthopedic	Aarskog syndrome, Angelman-like syndrome, Ataxia-oculomotor apraxia type 1, Central core myopathy, Central nervous system angiitis, Centronuclear myopathy, Congenital fiber-type disproportion myopathy, Duane ocular retraction syndrome, Ehlers danlos syndrome, Kufor-rakeb syndrome, Lambert-eaton myasthenic syndrome, Limb-girdle muscular dystrophy , Multicore myopathy, Myasthenia gravis, Myoneurogastrointestinal encephalopathy syndrome, Myotubular myopathy , Oculopharyngeal muscular dystrophy, Rheumatoid arthritis
Neurologic	Acute disseminated encephalomyelitis, Angelman-like syndrome, Arachnoid cyst, Ataxia-oculomotor apraxia type 1, Ataxia-oculomotor apraxia type 2, Athabaskan brain stem dysgenesis, Autosomal-dominant progressive external opthalmoplegia (adPEO), Basilar artery migraine, Benedikt syndrome, Berry aneurysm, Bickerstaff's brain stem encephalitis, Brain abscess, Brain injury, Brain tumour, Cavernous sinus dural arteriovenous fistula , Cavernous sinus thrombosis, Central core myopathy, Central nervous system angiitis, Centronuclear myopathy, Christianson type x-linked mental retardation, Claude syndrome, Clinically isolated syndrome (CIS), Dermoid cyst, Foville's syndrome, Friedreich ataxia, Graves' disease, Growth hormone secreting pituitary adenoma, Guillain-barre syndrome , Horner's syndrome, Infantile-onset spinocerebellar ataxia, Intracranial aneurysm, Intracranial space-occupying lesion, Ischemia , Kearns-sayre syndrome, Kufor-rakeb syndrome, Lambert-eaton myasthenic syndrome, Lateral medullary syndrome, Levic-stefanovic-nikolic syndrome , Miller fisher syndrome, Multicore myopathy, Multiple sclerosis, Myasthenia gravis, Myoneurogastrointestinal encephalopathy syndrome, Myotubular myopathy , Neuromyelitis optica, Neurosarcoidosis, Niemann-pick disease, Nothnagel syndrome, Olivopontocerebellar syndrome, Pancoast tumour, Paraneoplastic encephalomyelitis, Parinaud's syndrome , Pituitary apoplexy, Progressive supranuclear palsy, Pseudoophthalmoplegia, Pseudotumor cerebri, Quaternary syphilis, Raised intracranial pressure, Raymond cestan syndrome, Rhino-orbital-cerebral mucormycosis , Rollet syndrome , Sturge-Weber syndrome, Subarchnoid hemorrhage, Subdural hematoma, Syringobulbia, Tick paralysis, Tolosa-hunt syndrome, Transverse myelitis, Vertebrobasilar insufficiency, Weber syndrome, Wildervanck syndrome
Nutritional/Metabolic	Fatty acid hydroxylase-associated neurodegeneration, Hypermagnesemia, Hypocalcemia , Magnesium sulfate, Niemann-pick disease, Thiamine deficiency, Uremia, Wernicke-korsakoff syndrome
Obstetric/Gynecologic	Postnatal trauma
Oncologic	Arachnoid cyst, Brain tumour, Carcinoma lung, Dermoid cyst, Intracranial space-occupying lesion, Melanoma-associated retinopathy, Metastasis, Nasopharyngeal carcinoma, Neck masses, Orbital tumors , Paraneoplastic encephalomyelitis, Paraneoplastic optic neuritis
Ophthalmologic	Agenesis of extraocular muscles, Arias oculootoradial syndrome, Ataxia-oculomotor apraxia type 1, Ataxia-oculomotor apraxia type 2, Autosomal-dominant progressive external opthalmoplegia (adPEO), Bacterial conjunctivitis, Blepharitis, Clinically isolated syndrome (CIS), Congenital fiber-type disproportion myopathy, Congenital fibrosis of extraocular muscles(FEOM), Corneal erosion, Corneal ulcer, Duane ocular retraction syndrome, Ehlers danlos syndrome, Episcleritis, Exophthalmos, Eye Packing, Familial horizontal gaze palsy with progressive scoliosis, Fungal conjunctivitis, Inflamed pterygium, Kearns-sayre syndrome, Levic-stefanovic-nikolic syndrome , Melanoma-associated retinopathy, Neuromyelitis optica, Oculopharyngeal muscular dystrophy, Optic neuritis, Orbital fracture with nerve entrapment, Orbital pseudotumor, Orbital tumors , Paraneoplastic optic neuritis, Periorbital cellulitis, Preseptal cellulitis, Progressive supranuclear palsy, Pseudoophthalmoplegia, Raymond cestan syndrome, Rhino-orbital-cerebral mucormycosis , Rollet syndrome , Scleritis, Sjögren syndrome, Superior orbital fissure syndrome, Tolosa-hunt syndrome, Trachoma, Wildervanck syndrome
Overdose/Toxicity	No underlying causes
Psychiatric	No underlying causes
Pulmonary	Carcinoma lung, Pancoast tumour
Renal/Electrolyte	Polycystic kidney disease , Uremia
Rheumatology/Immunology/Allergy	Bickerstaff's brain stem encephalitis, Inflammatory bowel disease, Microscopic polyangiitis, Neurosarcoidosis, Optic neuritis, Rheumatoid arthritis, Scleroderma, Sjögren syndrome, Systemic lupus erythematosus, Systemic sclerosis , Wegener's syndrome
Sexual	Aarskog syndrome
Trauma	Brain injury, Orbital fracture with nerve entrapment, Postnatal trauma
Urologic	No underlying causes
Miscellaneous	No underlying causes

Causes in Alphabetical Order

• Disease A
• Disease B
• Disease C
• Disease ...

• Disease P
• Disease Q
• Disease R
• Disease ...

• Disease X
• Disease Y
• Disease Z

Differentiating Opthalmoparesis from other Conditions

• Acute cranial polyneuropathy
• Adie syndrome
• Bilateral third nerve involvement
• Botulism
• Brainstem stroke
• Diptheria
• Drugs
• Iris injury
• Meningitis
• Myasthenia gravis
• Tetanus
• Midbrain lesion
• Vasculitis

Treatment

Treatment depend on the underlying condition.

Related Chapters

• Paresis

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