Internal Ophthalmoplegia Research Articles

Guillain-Barré syndrome presenting with signs of ophthalmoplegia

Two cases of Guillain-Barré syndrome (GBS) presenting with signs of ophthalmoplegia were reported. One showed unilateral internal ophthalmoplegia without external ophthalmoplegia, and the other displayed partial external ophthalmoplegia with sluggish pupillary response to light. It is important to keep in mind the possibility of GBS with acute onset of internal and/or external ophthalmoplegias.

Internal Ophthalmoplegia Following Inferior Oblique Myectomy: A Report of Three Cases

Three patients are reported in whom paralysis of accommodation and mydriasis (internal ophthalmoplegia) developed following inferior oblique myectomy. In all three patients, accommodation eventually returned to normal; in two, mild anisocoria persisted; in one patient, pupillotonia was noted after 2 1/2 years. The mechanism of this previously unreported surgical complication is thought to be excessive stretching of the nerve to the inferior oblique muscle with secondary trauma to the ciliary ganglion.

Cryptococcal Meningitis and Internal Ophthalmoplegia

A 17-year old girl received prednisone and azathioprine for the treatment of systemic lupus erythematosus. She developed a fever and hallucinations 18 months later; cryptococcal meningitis was diagnosed. An internal ophthalmoplegia with loss of accommodation and dilation of the pupils developed together with bilateral lateral rectus palsy. Treatment with intravenous amphotericin resulted in disappearance of papilledema, muscle palsy, and internal ophthalmoplegia. We believe that the internal ophthalmoplegia was secondary to involvement of the accommodative and pupillary fibers of both third nerves at the base of the brain.

Uveitis and Ophthalmoplegia Complicating Chickenpox

Two cases of unilateral uveitis which appeared in association with chickenpox are presented. In one of them internal ophthalmoplegia was seen. Possible pathogenic mechanisms are discussed. The unusual cycloplegia which was present in one case can be caused by viral lesion to the ciliary nerves.

Postganglionic cholinergic dysautonomia

A 9-year-old boy presented with symptoms and signs of marked postganglionic cholinergic autonomic dysfunction manifested by bilateral internal ophthalmoplegia, impaired secretion of tears and saliva, lack of gastrointestinal motility, atony of the bladder, generalized absence of sweating, and hypertension. Clinical and pharmacological studies confirmed that the abnormalities were restricted mainly to the postganglionic cholinergic autonomic system and showed evidence of postdenervation supersensitivity to parasympathomimetic drugs. The patient was treated in the early phase of his illness by the administration of carbachol, and eventually he made a slow and partial spontaneous recovery. Histoimmunofluorescent studies on a skin biopsy specimen suggested an autoimmune origin for his disease, with IgG antibodies being produced against postganglionic cholinergic autonomic fibers.

Bilateral internal ophthalmoplegia in a patient with sarcoidosis.

Ocular signs are common in systemic sarcoidosis. Upwards of 50 per cent. of affected patients develop a granulomatous anterior uveitis, and fundus lesions are frequently observed. Ocular findings due to central nervous system involvement are less frequent, but can be the initial complaint. The subject of central nervous system involvement in sarcoidosis has been reviewed by Colover (I948) and Walsh and Hoyt (i 969a). In this paper, we report a patient whose initial ocular manifestation of sarcoidosis was an internal ophthalmoplegia. Her systemic illness went undiagnosed for many months until she developed a severe bilateral granulomatous uveitis and secondary glaucoma. The literature dealing with internal ophthalmoplegia in sarcoidosis is reviewed.

Subacute dysautonomia with incomplete recovery.

A 19-year-old woman presented with internal ophthalmoplegia, dryness of mouth, ileus, bladder paralysis and anhidrosis. She had an incomplete recovery in 28 months. Clinical and pharmacological examination showed impairment of peripheral autonomic functions governed by cholinergic parasympathetic and sympathetic nerves, probably caused by an impaired synthesis or release of acetylcholine in post-ganglionary autonomic nerves. Electron microscopy revealed no abnormality of skin nerve fibres. The site of the lesion resembles that seen in some cases of botulism, but the protracted course of the present case is unique. Its etiology remains obscure.

The Fixed Dilated Pupil

Isolated iridoplegia or internal ophthalmoplegia may be due to impairment of the effector muscles in the eye, defective parasympathetic innervation, or the presence of atropinic substances in the eye. Pharmacologic blockade can be identified by the pupil's failure to constrict to pilocarpine drops. Because of its clarity and technical simplicity, this test should be in general use as an office procedure.

Unilateral Internal Ophthalmoplegia with Intracranial Aneurysm: Report of a Case

Unilateral Internal Ophthalmoplegia with Intracranial Aneurysm: Report of a Case

INTERNAL OPHTHALMOPLEGIA FOLLOWING CHICKENPOX.

Few reported cases of internal ophthalmoplegia can be attributed to chickenpox, and the following case is therefore presented. Laha and Srivastava 1 in 1955 reported a 22-year-old Hindu male who noted monocular dimness of vision and dilated pupil one week after the onset of chickenpox, but no measurement of visual acuity nor accommodation was recorded. In 1958 Monod 2 described a 7-year-old girl who was noted to have a dilated pupil six days after the onset of chicken pox. Forty days after the onset of the illness the vision in the left eye was reduced to 9/10, presumably due to paresis of accommodation. Three months later the child had regained her power of accommodation, but the pupil remained dilated after 4½ months of observation. The latest report of internal ophthalmoplegia due to chickenpox was that by Ross 3 in 1961. He reported a 7-year-old white boy with 1.25 D of

OCULOMOTOR PARALYSIS WITH PARTIAL RECOVERY

Lesions of the third, fourth and sixth cranial nerves are always of interest to the neurologist and the ophthalmologist. Lesions of the third nerve, particularly, attract a great deal of attention because of the widespread distribution of this nerve. The present case is one of paralysis of the third nerve with internal and external ophthalmoplegia in which abnormal reactions to drugs were exhibited. The patient was observed over a long period, during which there was partial recovery with corresponding changes in the drug reactions and the appearance of the pseudo-Graefe phenomenon. A white woman aged 68 was first observed at the Montefiore Hospital in January 1944. The history of her symptoms dated back to May 1943, at which time she complained of the sudden onset of pain in the left side of the head followed by gradual closing of the left eye in the next six days. Soon after the

UNILATERAL INTERNAL OPHTHALMOPLEGIA: SOLE CLINICAL SIGN IN PATIENT WITH SYPHILITIC MENINGITIS

The occurrence of any form of internal ophthalmoplegia always arouses the clinical interest and frequently presents itself as a diagnostic challenge to the examiner. It is well known that disturbances of ocular function, especially pupillary, are commonly encountered in patients with syphilitic involvement of the central nervous system. However, the presence of total internal ophthalmoplegia of one eye as the only clinical sign of syphilis of the central nervous system is extremely rare. A review of the medical literature of the past decade ( Quarterly Cumulative Index Medicus , 1935-1945) reveals no report in English describing such an occurrence. In 1935 Puglisi-Duranti, 1 a Spanish ophthalmologist, reported a total of 3 cases of internal ophthalmoplegia as an isolated clinical phenomenon. In 1937 he reported 1 additional case. 2 In 2 of these 4 cases the author described syphilis as the underlying cause of the ocular disturbance. The first case was that of

EXPERIMENTAL PTOSIS IN PRIMATES

The upper eyelid is raised by the action of the levator palpebrae superioris and Muller's palpebral muscle. The former is innervated by the oculomotor nerve and the latter by fibers from the cervical portion of the sympathetic trunk. Ptosis of the upper lid follows paralysis of either nerve supply, that due to a lesion of the oculomotor nerve being greater than the slight droop which is seen in Horner's syndrome1due to involvement of the cervical portion of the sympathetic trunk (figure,A). Likewise, there is limitation of the upward excursion of the lid when the eyeball is elevated in disorders referable to the oculomotor nerve while in disturbances of the sympathetic innervation the amplitude is normal. With section of the third nerve mydriasis occurs as well as external and internal ophthalmoplegia, while a lesion of the sympathetic trunk causes miosis and enophthalmos. This communication deals with ptosis produced

TONIC PUPILS AND ABSENT TENDON REFLEXES: A BENIGN DISORDER SUI GENERIS; ITS COMPLETE AND INCOMPLETE FORMS

Every experienced neurologist has seen a few patients with absence of the tendon reflexes for which no cause could be found. Acting on the suggestion of Dr. James Collier, I mention these cases here and submit that some of them are incomplete examples of this disorder. For proof I await a case in which a tonic pupil appears under observation. If my views are correct the disorder I am describing may manifest itself in the folowing forms:— (1) The complete from —typical tonic pupil and absence of reflexes. (2) Incomplete forms: (a) tonic pupil alone; (b) atypical phases of the tonic pupil alone (iridoplegia; internal ophthalmoplegia); (c) atypical phases of the tonic pupil with absent reflexes; (d) absent reflexes alone. The Tonic Pupil. In its most characteristic form the tonic pupil is usually unilateral and almost always larger than its normal fellow; it is never miotic.

Case of One-Sided Internal Ophthalmoplegia

Case of One-Sided Internal Ophthalmoplegia