Ophthalmoplegia: Understanding the Basics

ophthalmoplegia
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Meaning of ophthalmoplegia

Ophthalmoplegia is paralysis or weakness of the eye muscles. The ocular muscles hold the eye in place and regulate motion, they are six in number namely: superior rectus, inferior rectus, lateral rectus, medial rectus, superior oblique, and the inferior oblique.

Ophthalmoplegia can either be chronic progressive external or internal.

Chronic progressive external ophthalmoplegia

It occurs in young adults between the ages of 18 and 40. It starts with ptosis (drooping eyelids) and difficulty controlling the muscles that coordinate the eyes.

Internuclear ophthalmoplegia

This is caused by nerve injury to the nerve that regulates the lateral movement of the eye. This results in diplopia (double vision). Often, it occurs as part of a syndrome. 

Symptoms of ophthalmoplegia

Many of the symptoms are related to the eye except the condition occurs as part of a syndrome and in which case it will have systemic symptoms such as difficulty in swallowing and muscle weakness. The eye symptoms include:

  • Blurry vision
  • Double vision
  • Drooping of the eyelids
  • Inability to position the eye in synchrony
  • Difficulty with moving both eyes in every direction

Causes of ophthalmoplegia

This condition may be congenital, meaning it is present at birth or it can be acquired. The main problem here is that there is an alteration in the signals that are transmitted from the brain to the eyes.

Trauma, infarction, or multiple sclerosis can lead to internal ophthalmoplegia.

Muscle or mitochondrial disorders such as Grave’s disease can lead to external ophthalmoplegia.

Other common causes include:

  • Migraine
  • Thyroid disorder
  • Brain trauma
  • Brain tumor
  • Stroke
  • Infection

Risk factors for ophthalmoplegia

Ophthalmoplegia can be a resulting complication of diabetes mellitus, especially type 2. It is commoner in men above the age of 45 who have had a ten-year history of diabetes.

Muscle conditions seen in diseases such as Grave’s disease or multiple sclerosis are more susceptible to developing the condition.

There is no recognized lifestyle risk factor for this condition but it is necessary to ensure that the circulatory system is healthy enough to reduce the chances of developing stroke and visual disturbances.

Diagnosis of ophthalmoplegia

It can be diagnosed clinically by performing a physical examination to check the eye movements. This examination can be conducted by a neurologist or an eye specialist. The eye can be further studied closely by the aid of an MRI or a CT scan.

Thyroid disease can be ascertained via a blood test and this is a recognized cause of ophthalmoplegia.

Treatment of ophthalmoplegia

Treatment of this condition depends on the type, the symptoms manifested, and the cause.

When congenital, the children may learn to compensate and may not be aware of the visual impairment.

Adults may opt for special glasses or wear an eye patch to help with double vision.

Other times, the treatment of migraines may produce better outcomes for people with ophthalmoplegia.

Complications

Close observation is necessary for those diagnosed with ophthalmoplegia as there could be worsening of the muscle weakness or a genetic syndrome could develop.

Ensure to see a doctor if you experience double vision, blurry vision, floaters, dizziness or a sudden severe headache.

Prevention

Early detection is the key as often time, ophthalmoplegia is a symptom of another syndrome. Paying regular visits to a doctor will lead to early detection.

The center for disease control (CDC) recommends a 2-yearly eye check for those with normal vision.

The eye muscles are sensitive and their functionality is dependent upon a healthy nervous and blood supply.

Outlook

When ophthalmoplegia occurs in isolation, the life expectancy is as with that of the normal population.

The prognosis is dependent on the cause. Worse outcomes are seen in genetic and mitochondrial disease, history of stroke, or genetic syndromes. The best outcome for this condition is the early detection and treatment of the underlying causes.