Painful ophthalmoplegia

Abstract

This chapter reviews a medical case of painful ophthalmoplegia. A 64-year-old woman was admitted to the Out Patient Department with a history of pain in the left eye, double vision, and drooping of the left eyelid. Six months previously, she had developed pain in and around the left eye, which she described as throbbing in character. The pain increased in severity to the extent that it kept her awake at night and that she needed to take larger doses of analgesics. After 3 months, she noticed double vision on gaze to the left, which gradually became more marked. In the previous 4 weeks, the left eyelid had drooped and this gradually increased in severity so that eventually the eye closed. The signs were those of a complete ophthalmoplegia because of involvement of the IIIrd, IVth, and VIth cranial nerves. The IVth nerve function is normally tested by asking the patient to look down with the eye adducted; in the presence of a IIIrd nerve palsy, however, the IVth nerve causes the eye to intort and may be tested by asking the patient to look down with the eye in abduction.