Ophthalmoparesis: Difference between revisions

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{{Ophthalmoparesis}}
 
'''For patient information click [[{{PAGENAME}} (patient information)|here]]'''
 
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==Overview==
{{SK}} Ophthalmoplegia
'''Ophthalmoparesis''' is a physical finding in certain [[neurology|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 overview|Overview]]==
Ophthalmoparesis can involve any or all of the extraocular muscles, which include the [[superior rectus muscle|superior recti]], [[inferior rectus muscle|inferior recti]], [[medial rectus muscle|medial recti]], [[lateral rectus muscle|lateral recti]], [[inferior oblique muscle|inferior oblique]] and [[superior oblique muscle]]s. 


It can also be classified by the directions of affected movements, e.g. "vertical ophthalmoparesis".
==[[Ophthalmoparesis historical perspective|Historical Perspective]]==


Types of ophthalmoplegia are:
==[[Ophthalmoparesis classification|Classification]]==
*[[Progressive external ophthalmoplegia]]
*[[Supranuclear ophthalmoplegia]]
==Causes==
Ophthalmoparesis can result from disorders of various parts of the eye and nervous system:


* The [[orbit (anatomy)|orbit]] of the eye, including mechanical restrictions of eye movement, as in [[Graves' disease|Graves disease]].
==[[Ophthalmoparesis pathophysiology|Pathophysiology]]==
* The [[muscle]], as in [[progressive external ophthalmoplegia]] or [[Kearns-Sayre syndrome]]
* The [[neuromuscular junction]], as in [[myasthenia gravis]].
* The [[cranial nerves|cranial nerve]]s or their brainstem nuclei of the [[oculomotor nerve|oculomotor]], [[trochlear nerve|trochlear]], and [[abducens nerve|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 lobe]]s of the cerebral cortex.


[[Thiamine]] deficiency can cause '''ophthalmoparesis''' in susceptible persons; this is part of the syndrome called [[Wernicke's encephalopathy|Wernicke encephalopathy]].  The causal pathway by which this occurs is unknown.  Intoxication with certain substances, such as [[phenytoin]], can also cause ophthalmoparesis.
==[[Ophthalmoparesis causes|Causes]]==


===Common Causes===
==[[Ophthalmoparesis differential diagnosis|Differentiating Ophthalmoparesis from other Diseases]]==
*List the most common causes here.
===Causes by Organ System===
{|style="width:82%; height:100px" border="1"
|style="height:100px"; style="width:25%" border="1" bgcolor="LightSteelBlue" | '''Cardiovascular'''
|style="height:100px"; style="width:75%" border="1" bgcolor="Beige" | [[Carotid artery dissection]],  [[Carotid-cavernous fistula]],  [[Aortic coarctation|Coarctation of aorta]],  [[Hypertension]],  [[Ischemia|Ischemia ]]
|-
|-bgcolor="LightSteelBlue"
| '''Chemical/Poisoning'''
|bgcolor="Beige"| [[Amnesic shellfish poisoning]],  [[Aralytic shellfish poisoning|Aralytic shellfish poisoning ]],  [[Venomous snake|Atractaspididae (african mole viper)]],  [[Carbamate|Carbamates]],  [[Marine toxins|Ciguatera poisoning]],  [[Snakebites (Patient information)|Cobra poisoning ]],  [[Venomous snake|Colubridae (boomslang, twig snake)]],  Crotoxin [[Venomous snake|(Rattlesnake)]],  [[Venomous snake|Elapidae]],  [[Eurotoxic shellfish poisoning]],  [[Kraits]],  [[Mamba]] snake,  [[Notexin (tiger snake)]],  [[Organophosphate|Organophosphates]],  [[Scombroid food poisoning|Scombroid poisoning]],  [[Taipoxin]] (taipan),  [[Viperidae]] -[[bungarotoxin]]
|-
|-bgcolor="LightSteelBlue"
| '''Dental'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Dermatologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Drug Side Effect'''
|bgcolor="Beige"| [[Aminoglycoside|Aminoglycoside ]],  [[Atorvastatin]],  [[Beta blockers]],  [[Carbamate|Carbamates]],  [[Carbamazepine]],  [[Penicillamine|D-penicillamine]],  [[Quinolone|Fluoroquinolone ]],  [[Fluvastatin]],  [[Glucocorticoids]],  [[Gold]],  [[Lithium]],  [[Lovastatin]],  [[Organophosphate|Organophosphates]],  [[Phenytoin ]],  [[Pitavastatin]],  [[Pravastatin]],  [[Pregabalin]],  [[Simvastatin]],  [[Vincristine]]
|-
|-bgcolor="LightSteelBlue"
| '''Ear Nose Throat'''
|bgcolor="Beige"| [[Acute bacterial rhinosinusitis]],  [[Arias oculootoradial syndrome]],  [[Gradenigo-lannois syndrome]],  [[Nasopharyngeal carcinoma]],  [[Neck masses]],  [[Otitis media]],  [[Wildervanck syndrome]]
|-
|-bgcolor="LightSteelBlue"
| '''Endocrine'''
|bgcolor="Beige"| [[Diabetes mellitus]],  [[Graves' disease]],  [[Growth hormone secreting pituitary adenoma]]
|-
|-bgcolor="LightSteelBlue"
| '''Environmental'''
|bgcolor="Beige"| [[Alcoholism]],  [[Amnesic shellfish poisoning]],  [[Aralytic shellfish poisoning|Aralytic shellfish poisoning ]],  [[Atractaspididae (african mole viper)]],  [[Botulism]],  [[Carbamate|Carbamates]],  [[Marine toxins|Ciguatera poisoning]],  [[Snakebites (Patient information)|Cobra poisoning ]],  [[Colubridae (boomslang, twig snake)]],  [[Crotoxin (brazilian rattle snake)]],  [[Elapidae]],  [[Eurotoxic shellfish poisoning]],  [[Gold]],  [[Kraits]],  [[Mamba snake]],  [[Notexin (tiger snake)]],  [[Organophosphate|Organophosphates]],  [[Scombroid food poisoning|Scombroid poisoning]],  [[Taipoxin (taipan)]],  [[Thiamine deficiency]],  [[Tick paralysis]],  [[Toscana virus]],  [[Viperidae beta-bungarotoxin (krait)]],  [[Wernicke-korsakoff syndrome]]
|-
|-bgcolor="LightSteelBlue"
| '''Gastroenterologic'''
|bgcolor="Beige"| [[Inflammatory bowel disease]],  [[Myoneurogastrointestinal encephalopathy syndrome]],  [[Whipple's disease]],
|-
|-bgcolor="LightSteelBlue"
| '''Genetic'''
|bgcolor="Beige"| [[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]]
|-
|-bgcolor="LightSteelBlue"
| '''Hematologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Iatrogenic'''
|bgcolor="Beige"| [[Amnesic shellfish poisoning]],  [[Aralytic shellfish poisoning|Aralytic shellfish poisoning ]],  [[Atractaspididae (african mole viper)]],  [[Brain injury]],  [[Marine toxins|Ciguatera poisoning]],  [[Snakebites (Patient information)|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 food poisoning|Scombroid poisoning]],  [[Taipoxin (taipan)]],  [[Tick paralysis]],  [[Viperidae beta-bungarotoxin (krait)]]
|-
|-bgcolor="LightSteelBlue"
| '''Infectious Disease'''
|bgcolor="Beige"| [[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]]
|-
|-bgcolor="LightSteelBlue"
| '''Musculoskeletal/Orthopedic'''
|bgcolor="Beige"| [[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]]
|-
|-bgcolor="LightSteelBlue"
| '''Neurologic'''
|bgcolor="Beige"| [[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|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]]
|-
|-bgcolor="LightSteelBlue"
| '''Nutritional/Metabolic'''
|bgcolor="Beige"| [[Fatty acid hydroxylase-associated neurodegeneration]],  [[Hypermagnesemia]],  [[Hypocalcemia ]],  [[Magnesium sulfate]],  [[Niemann-pick disease]],  [[Thiamine deficiency]],  [[Uremia]],  [[Wernicke-korsakoff syndrome]]
|-
|-bgcolor="LightSteelBlue"
| '''Obstetric/Gynecologic'''
|bgcolor="Beige"|[[Postnatal trauma]]
|-
|-bgcolor="LightSteelBlue"
| '''Oncologic'''
|bgcolor="Beige"| [[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]]
|-
|-bgcolor="LightSteelBlue"
| '''Ophthalmologic'''
|bgcolor="Beige"| [[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]]
|-
|-bgcolor="LightSteelBlue"
| '''Overdose/Toxicity'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Psychiatric'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Pulmonary'''
|bgcolor="Beige"| [[Carcinoma lung]],  [[Pancoast tumour]]
|-
|-bgcolor="LightSteelBlue"
| '''Renal/Electrolyte'''
|bgcolor="Beige"| [[Polycystic kidney disease ]],  [[Uremia]]
|-
|-bgcolor="LightSteelBlue"
| '''Rheumatology/Immunology/Allergy'''
|bgcolor="Beige"| [[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]]
|-
|-bgcolor="LightSteelBlue"
| '''Sexual'''
|bgcolor="Beige"| [[Aarskog syndrome]]
|-
|-bgcolor="LightSteelBlue"
| '''Trauma'''
|bgcolor="Beige"| [[Brain injury]],  [[Orbital fracture with nerve entrapment]],  [[Postnatal trauma]]
|-
|-bgcolor="LightSteelBlue"
| '''Urologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Miscellaneous'''
|bgcolor="Beige"| No underlying causes
|-
|}


===Causes in Alphabetical Order===
==[[Ophthalmoparesis epidemiology and demographics|Epidemiology and Demographics]]==
{{col-begin|width=84%}}
{{col-break|width=33%}}
*[[Disease]] A
*[[Disease]] B
*[[Disease]] C
*[[Disease]] ...
{{col-break|width=33%}}
*[[Disease]] P
*[[Disease]] Q
*[[Disease]] R
*[[Disease]] ...
{{col-break|width=33%}}
*[[Disease]] X
*[[Disease]] Y
*[[Disease]] Z
{{col-end}}


==Differentiating Opthalmoparesis from other Conditions==
==[[Ophthalmoparesis risk factors|Risk Factors]]==
*Acute cranial polyneuropathy
 
*[[Adie syndrome]]
==[[Ophthalmoparesis natural history, complications and prognosis|Natural History, Complications and Prognosis]]==
*Bilateral third nerve involvement
 
*[[Botulism]]
==Diagnosis==
*Brainstem [[stroke]]
[[Ophthalmoparesis history and symptoms| History and Symptoms]] | [[Ophthalmoparesis physical examination | Physical Examination]] | [[Ophthalmoparesis laboratory findings|Laboratory Findings]] | [[Ophthalmoparesis CT|CT]] | [[Ophthalmoparesis other imaging findings|Other Imaging Findings]] | [[Ophthalmoparesis other diagnostic studies|Other Diagnostic Studies]]
*[[Diptheria]]
*[[Drugs]]
*Iris injury
*[[Meningitis]]
*[[Myasthenia gravis]]
*[[Tetanus]]
*Midbrain lesion
*[[Vasculitis]]


==Treatment==
==Treatment==
Treatment depend on the underlying condition.
[[Ophthalmoparesis medical therapy|Medical Therapy]] |  [[Ophthalmoparesis surgery|Surgery]] | [[Ophthalmoparesis primary prevention|Primary Prevention]] | [[Ophthalmoparesis secondary prevention|Secondary Prevention]] | [[Ophthalmoparesis cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Ophthalmoparesis future or investigational therapies|Future or Investigational Therapies]]
 
==Case Studies==
[[Ophthalmoparesis case study one|Case#1]]


==Related Chapters==
==Related Chapters==
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{{Eye pathology}}
{{Eye pathology}}
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[[Category:Neurology]]
[[Category:Neurology]]
[[Category:Medical signs]]
[[Category:Overview complete]]
[[Category:Overview complete]]
[[Category:Primary care]]
[[sv:Internukleär oftalmoplegi]]
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{{WikiDoc Sources}}

Latest revision as of 23:00, 29 July 2020


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

Synonyms and keywords: Ophthalmoplegia

Overview

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Epidemiology and Demographics

Risk Factors

Natural History, Complications and Prognosis

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