Ophthalmoparesis causes

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Mugilan Poongkunran M.B.B.S [2]

Causes

Common Causes

• Alcoholism

• Brain aneurysm

• Brain injury

• Brain tumour

• Congenital ophthalmoplegia

• Diabetes

• Meningitis
• Multiple sclerosis

• Myasthenia gravis

• Syphilis

• Syringobulbia

• Thyrotoxicosis

• Tuberculosis

• Wernicke's encephalopathy

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	Sturge-Weber syndrome
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 (rattlesnake), 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, Wernicke-korsakoff syndrome
Gastroenterologic	Inflammatory bowel disease, Myoneurogastrointestinal encephalopathy syndrome, Whipple's disease,
Genetic	Aarskog syndrome, Agenesis of extraocular muscles, Angelman 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(rattle snake), Eurotoxic shellfish poisoning, Eye Packing, Gold, Guillain-Barre syndrome , Kraits, Epidural anesthesia , Magnesium sulfate, Mamba snake, Notexin (tiger snake), Raised intracranial pressure, Scombroid poisoning, Taipoxin (taipan), Tick paralysis, Viperidae beta-bungarotoxin
Infectious Disease	Acute bacterial rhinosinusitis, Acute disseminated encephalomyelitis, Aspergillus, 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 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 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's 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's 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's syndrome, Systemic lupus erythematosus, Systemic sclerosis , Wegner'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

• Aarskog syndrome

• Acute bacterial rhinosinusitis

• Acute disseminated encephalomyelitis

• Agenesis of extraocular muscles

• Alcoholism

• Aminoglycoside

• Amnesic shellfish poisoning

• Angelman syndrome

• Arachnoid cyst

• Aralytic shellfish poisoning

• Arias oculootoradial syndrome

• Aspergillus

• Ataxia-oculomotor apraxia type 1

• Ataxia-oculomotor apraxia type 2

• Athabaskan brain stem dysgenesis

• Atorvastatin

• Atractaspididae (african mole viper)

• Autosomal-dominant progressive external opthalmoplegia (adPEO)

• Bacterial conjunctivitis

• Basilar artery migraine

• Benedikt's syndrome

• Berry aneurysm

• Beta blockers

• Bickerstaff's brain stem encephalitis

• Blepharitis

• Botulism

• Brain abscess

• Brain injury

• Brain tumour

• Carbamates

• Carbamazepine

• Carcinoma lung

• Carotid artery dissection

• Carotid-cavernous fistulas

• Cavernous sinus dural arteriovenous fistula

• Cavernous sinus thrombosis

• Central core myopathy

• Central nervous system angiitis

• Centronuclear myopathy

• Christianson type x-linked mental retardation

• Ciguatera poisoning

• Claude syndrome

• Clinically isolated syndrome (CIS)

• Coarctation of aorta

• Cobra poisoning

• Colubridae (boomslang, twig snake)

• Congenital fiber-type disproportion myopathy

• Congenital fibrosis of extraocular muscles(FEOM)

• Corneal erosion

• Corneal ulcer

• Crotoxin (rattlesnake)

• Dermoid cyst

• Diabetes mellitus

• D-penicillamine

• Duane ocular retraction syndrome

• Ehlers Danlos syndrome

• Elapidae

• Episcleritis

• Eurotoxic shellfish poisoning

• Exophthalmos

• Eye Packing

• Familial horizontal gaze palsy with progressive scoliosis

• Fatty acid hydroxylase-associated neurodegeneration

• Fluoroquinolone

• Fluvastatin

• Foville's syndrome

• Friedreich ataxia

• Fungal conjunctivitis

• Glucocorticoids

• Gold

• Gradenigo-lannois syndrome

• Graves' disease

• Growth hormone secreting pituitary adenoma

• Guillain-Barre syndrome

• Horner's syndrome

• Hypermagnesemia

• Hypertension

• Hypocalcemia

• Infantile-onset spinocerebellar ataxia

• Infection

• Inflamed pterygium

• Inflammatory bowel disease

• Intracranial aneurysm

• Intracranial space-occupying lesion

• Ischemia

• Kearns-Sayre syndrome

• Koerber-Salus-Elshnig syndrome

• Kraits

• Kufor-rakeb syndrome

• Lambert-Eaton myasthenic syndrome

• Lateral medullary syndrome

• Levic-stefanovic-nikolic syndrome

• Limb-girdle muscular dystrophy

• Lithium

• Lovastatin

• Epidural anesthesia

• Magnesium sulfate

• Mamba snake

• Melanoma-associated retinopathy

• MELAS syndrome

• Meningitis

• Metastasis

• Microscopic polyangiitis

• Miller fisher syndrome

• Mobius syndrome

• Multicore myopathy

• Multiple sclerosis

• Myasthenia gravis

• Myoneurogastrointestinal encephalopathy syndrome

• Myotubular myopathy

• Nasopharyngeal carcinoma

• Neck masses

• Neuromyelitis optica

• Neurosarcoidosis

• Niemann-Pick disease

• Notexin (tiger snake)

• Nothnagel syndrome

• Oculopharyngeal muscular dystrophy

• Olivopontocerebellar syndrome

• Optic neuritis

• Orbital fracture with nerve entrapment

• Orbital pseudotumor

• Orbital tumors

• Organophosphates

• Otitis media

• Pancoast tumour

• Paraneoplastic encephalomyelitis

• Paraneoplastic optic neuritis

• Parinaud's syndrome

• Periorbital cellulitis

• Phenytoin

• Pitavastatin

• Pituitary apoplexy

• Polycystic kidney disease

• Postnatal trauma

• Pravastatin

• Pregabalin

• Preseptal cellulitis

• Progressive supranuclear palsy

• Pseudoophthalmoplegia

• Pseudotumor cerebri

• Quaternary syphilis

• Rabies

• Raised intracranial pressure

• Raymond cestan syndrome

• Rheumatoid arthritis

• Rhino-orbital-cerebralmucormycosis

• Rollet syndrome

• Scleritis

• Scleroderma

• Scombroid poisoning

• Simvastatin

• Sjögren syndrome

• Steele-richardson-olszewski syndrome

• Sturge-Weber syndrome

• Subarchnoid hemorrhage

• Subdural hematoma

• Superior orbital fissure syndrome

• Syringobulbia

• Systemic lupus erythematosus

• Systemic sclerosis

• Taipoxin(taipan)

• Thiamine deficiency

• Tick paralysis

• Tolosa-hunt syndrome

• Toscana virus

• Trachoma

• Transverse myelitis

• Tuberculosis

• Uremia

• Vertebrobasilar insufficiency

• Vincristine

• Viperidae beta-bungarotoxin (krait)

• Weber syndrome

• Wegener's syndrome

• Wernicke-korsakoff syndrome

• Whipple's disease

• Wildervanck syndrome

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 relevant cranial nerves (specifically the oculomotor, trochlear, and abducens), as in cavernous sinus syndrome or raised intracranial pressure.

The brainstem nuclei of these nerves, as in certain patterns of brainstem stroke such as Foville's syndrome.

White matter tracts connecting these nuclei, as in internuclear ophthalmoplegia, an occasional finding in multiple sclerosis.

Dorsal midbrain structures, as in Parinaud's syndrome.

Certain parts of the cerebral cortex (including the frontal eye fields), as in stroke.

Toxic envenomation by mambas, taipans, and kraits.

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.