ophthalmoplegia

Ophthalmoplegia - paralysis of the eye muscles due to lesions of the oculomotor nerve.

Etiology, pathogenesis. Aneurysms vascular arterial circle of the brain (circle of Willis), basal brain tumor, hernial protrusion of the brain through the hole cerebellar tentorium with increasing intrakraniap-foot pressure, ischemic neuropathy, oculomotor nerve, brain stem lesion (stroke, tumor, encephalitis, alcoholic encephalopathy), multiple sclerosis , botulism, septic thrombosis and other disorders of the cavernous sinus, meningitis. In all these cases ophthalmoplegia is neurogenic character. The reasons for the immediate destruction of ocular muscles often are male, endocrine ophthalmopathy, orbit tumors, ocular myopathy.

Symptoms. Mobility limitation eyeball, double vision, often ptosis. With involvement of autonomic fibers - mydriasis, disturbance of pupillary reactions. For aneurysms vascular circle of Willis is characterized by a combination of ophthalmoplegia with the defeat of the first branch of the trigeminal nerve (pain in the eye and in the frontal region). The syndrome of the cavernous sinus consists of a full or partial internal and external ophthalmoplegia and losing 1 and II of the branches of the trigeminal nerve (pain in the eye, the frontal region, cheek and upper jaw). This syndrome is often caused by a tumor, located near the Turkish saddle. Thrombosis of the cavernous sinus ophthalmoplegia accompanied by exophthalmos, headache, swelling periorbitapnyh tissue and conjunctiva, the fall of; if the thrombosis is septic character symptoms obscheinfektsionnogo character join. When carotid-cavernous fistula ophthalmoplegia combined with pulsating exophthalmos, conjunctival hyperemia and vascular noise on auscultation eyes and the eponymous half head.

A special version of the lesion of oculomotor nerves - Toulouse syndrome - Hunt or painful ophthalmoplegia - disease adjacent to the group of collagen diseases caused by arteritis of the carotid artery in the cavernous sinus. Clinical picture: acute developing ophthalmoplegia with sharp pain in the orbit and frontal region; usually there is an increase in ESR. Diagnostics contributes almost unchanged rapid regression of the disease in the appointment of glucocorticoid hormones (60 mg prednisolone). It should be borne in mind that simptokompleks painful ophthalmoplegia may occur in other diseases: ethmoidal sinusitis, abscess superior orbital fissure, aneurysm, temporal arteritis, oftalmoplegicheskaya migraine, thrombosis of the cavernous sinus, herpes zoster ophthalmicus. The reason for the defeat directly outside eye muscles often is myasthenia gravis, in which usually takes place bilateral ophthalmoplegia without involving the pupils. Exophthalmic ophthalmoplegia (endocrine orbitopathy) is caused by excessive secretion of ekzoftalmogennogo factor pituitary and special substance of thyroid hormone. Clinical picture: exophthalmos (sometimes one-sided), a sharp swelling periorbitapnyh tissue, conjunctivitis, eye pain, increased density retrookulyarnyh tissues and disruption of the mobility of the eye, especially up- When ehoorbitografii revealed thickening of the outer eye muscles.

Isolated internal ophthalmoplegia usually occurs within Adie syndrome (see.).

Paraclinical studies at ophthalmoplegia: craniography, computed tomography, ehoorbitografiya (verification intraorbital processes), angiography.

Improving the mobility of the eye after the injection of neostigmine indicates myasthenic genesis of the disease.