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What is ophthalmoplegia?

Ophthalmoplegia is the paralysis or weakness of the eye muscles. It can affect one or more of the six muscles that hold the eye in place and control its movement.

There are two types of ophthalmoplegia: chronic progressive external ophthalmoplegia and internal ophthalmoplegia.

Chronic progressive external ophthalmoplegia

Chronic progressive external ophthalmoplegia typically appears in adults between the ages of 18 and 40 years. It typically begins with drooping eyelids and difficulty controlling the muscles that coordinate the eyes.

Internuclear ophthalmplegia

Internulcear ophthalmoplegia is caused by nerve damage to the nerve fibers that coordinate lateral eye movement. This leads to double vision. This condition is associated with some other disorders.

What are the symptoms of ophthalmoplegia?

People affected by ophthalmoplegia may have double or blurred vision. They may also experience an inability to position the eyes in sync. Some may also have a hard time moving both eyes in every direction, and many will have drooping of their eyelids.

If ophthalmoplegia is associated with a systemic disorder, other symptoms may include difficulty swallowing and general muscle weakness.

What causes ophthalmoplegia?

This condition can be congenital (present at birth) or develop later in life. It is generally caused by disruption of the messages that are sent from the brain to the eyes.

Internuclear ophthalmoplegia is often caused by multiple sclerosis, trauma, or infarction.

External ophthalmoplegia is usually caused by muscle disorders or mitochondrial diseases such as Graves’ disease or Kearns-Sayre syndrome.

Other common causes include:

  • migraines
  • thyroid disease
  • stroke
  • brain injury
  • brain tumor
  • infection

Ophthalmoplegia risk factors

Ophthalmoplegia is slightly more likely to occur in people with diabetes. Men with diabetes who are over the age of 45 and have had type 2 diabetes for more than 10 years were recently identified as a higher risk category for developing ophthalmoplegia.

People that have a condition that affects their muscle control, such as multiple sclerosis or Graves’ disease, are more at risk than others. In general, there are no lifestyle choice factors that contribute to being at risk for ophthalmoplegia. But keeping a healthy vascular system by maintaining a balanced lifestyle will lessen your risk of stroke and related vision problems.

How is ophthalmoplegia diagnosed?

Ophthalmoplegia can be diagnosed with a physical examination to check eye movements. Then an MRI or CT scan may be used to study the eye more closely.

Blood tests may be necessary to determine whether it’s being caused by another condition, such as thyroid disease. You may be referred to an eye specialist or neurologist for these tests.

How is ophthalmoplegia treated?

Treatment for ophthalmoplegia will depend on the type, symptoms, and underlying cause. Children born with this condition usually learn to compensate and may not be aware of vision problems. Adults can be fitted for special glasses, or wear an eye patch to relieve double vision and help achieve normal vision.

In some cases, treatment of migraines can lead to improved outcomes for people with ophthalmoplegia.

Complications of ophthalmoplegia

If you have been diagnosed with ophthalmoplegia, you are probably under observation for any changes in muscle weakness or development of a genetic syndrome. It’s possible that the degree of muscle control you have will lessen over time. If you experience blurred vision, double vision, "floaters" in your vision, a sudden escalating headache, or dizziness, contact your doctor.

Prevention of ophthalmoplegia

Ophthalmoplegia is most often a symptom of another syndrome or disease. But regular trips to the eye doctor may aid in early detection. Even if you have normal vision, it’s recommended that you visit an eye specialist about every two years. The eye has delicate muscles that depends on a healthy nervous and vascular system to function correctly.

Outlook for ophthalmoplegia

People that have isolated ophthalmoplegia tend to have a standard life expectancy. The underlying cause of your ophthalmoplegia will affect your overall prognosis. Genetic and mitochondrial diseases, a history of vascular disease or stroke, or genetic syndromes can vary your outlook drastically. It’s important to discover, address, and treat the cause of your ophthalmoplegia for the best outcome.

Content licensed from:

Written by: Amber Erickson Gabbey and Kathryn Watson
Medically reviewed on: Dec 14, 2016: Elaine Luo, MD

This feature is for informational purposes only and should not be used to replace the care and information received from your health care provider. Please consult a health care professional with any health concerns you may have.
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