|Year : 1982 | Volume
| Issue : 5 | Page : 471-472
A clinical study of ophthalmoplegia
PK Agrawal, NK Mishra, P Kala, D Nag
Department of Ophthalmology, K.G. Medical College, Lucknow, India
P K Agrawal
K.G. Medical College, Lucknow
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Agrawal P K, Mishra N K, Kala P, Nag D. A clinical study of ophthalmoplegia. Indian J Ophthalmol 1982;30:471-2
Large number of cases of Ophthalmoplegia, in spite of thorough investigations etiological speculations range from tuberculosis, autoimmune disorder to nonspecific inflammations. The present study was undertaken with a view to ascertain the etiology of ophthalmoplegia and the various clinical aspects of the condition in this part of the country.
| Methods and material|| |
This study was conducted in the Department of Ophthalmology, K.G. Medical College, Lucknow, including, patients departments of the Gandhi Memorial and Associated Hospitals, Lucknow from July 79 to June 80. We have only included the patients of painful or painless ophthalmoplegia involving the III, IV or VI nerves either singly or in combinations. The cases of congenital origin, birth trauma, nuclear or supranuclear lesions, purely internal ophthalmoplegia and ophthalmoplegia due to primary involvement of the ocular muscles were excluded from the study.
62 patients of ophtlialmoplegia were interrogated in detail regarding chief complaints, history of present and past illness. A thorough examination was done and the patients were subjected to a battery of necessary investigations to determine the exact etiology.
| Observations and discussion|| |
A total of 62 cases of ophthalmoplegia were included in the study. The mean age of the patients presenting with ophthalmoplegia in the present study was 31.9 years. The largest number belonging to the 20 to 40 years age group. The male female ratio was 2 : 1.
The presenting symptoms of the cases of ophthalmoplegia were pain in the eyes and the distribution of various cranial nerve palsies of various etiologies in [Table 3]. It was observed that single ocular nerve involvement was present in 83.9% (52) cases and combined involvement of two or more nerves was observed in 16.1% (10) cases. The most frequently affected nerve was VI nerve (45.2%) (28), both in solitary and in combination with other occulomotor nerves 59.7% (37). This was followed by the involvement of III and IV nerves in 29% (9) and 9.6°(6) cases as solitary involvement and 45% (28) and 25.6% in combinations respectively.
All the cases in the study group were investigated thoroughly; a large number of cases the aetiological diagnosis remained evasive.
The majority of patients of this condition presented in the 20-40 years age group followed by those above 40 years. The condition shows predilection for the young and middle age. There is a preponderance for the male though it is prevalent in both sexes. Male female ratio being 3 : 1 in the present study.
The presenting feature of these cases were general constitutional symptoms eg. headache, malaise & mild fever in 68% (15 cases) alongwith continuous boring pain in the eyes in 68% (17) cases. A few cases also had vertigo and giddiness (12% in 3 cases). These symptoms were followed by diplopia in 76% (19 cases) and diminution of vision in 24% (6 cases)-the latter were unable to appreciat( diplopia due to poor vision.
Characteristic feature of this conditior was the involvement of the oculomotor nerve; which was strictly unilateral during the attack The contra lateral nerves were involved in cases but in subsequent attacks. Recurrence of the condition was observed in these two cases only. The incidence of various ccculomoto] nerve involvements have been shown it [Table 3].
80% (20 cases) were put on Prednisolone 1 mg/kg body weight in divided dose. This was maintained for a week and then tapered off gradually over a month. Patients who presented early i.e. within 5 weeks from the onset of symptoms showed remarkable recovery (16 cases) out of the 17 showed complete recovery, whereas only 2 out of 3 cases presenting after 5 weeks recovered. Thus it was the recovery. This was especially so in the recovery of ocular movements and vision. Incidence of optic atrophy and diminution of vision it was noted 12% (3 cases) each. It was observed that visual recovery following treatment occurred in 2 of the 3 patients in the latter groups but not in the group with optic atrophy. This emphasises the urgent need for early detection and treatment of these cases with cortisone before irreversible and permanent damage leading to optic atrophy occurs.
From the clinical history, raised ESR and dramatic response to steroids, it may be inferred that the pathological process is a result of some immuno-allergic lesino Immunological studies using modern techniques may be helpful in ascertaining the presence and nature of immu-allergic phenomenon.
The second largest group of cases of ophthalmoplegia was of traumatic origin 17.6% (11 cases). The most frequently affec ted nerve was the VI followed by the III and IV both as solitary involvement as well as in combination. All the four cases of III nerve involvement in this group had involvement of pupillary fibres also. Of significance was the finding that ophthalmoplegia which occurred immediately following trauma (6 cases) 9.6% had a poorer prognosis as regards recovery, as compared to the other group who developed it after two to six days, 8% (5 cases).
16.1% (10 cases) belonged to the inflammatory group. The incidence of involvement by different inflammatory pathologies has been shown in [Table 3]. Diagnosis was confirmed in 3 cases only of orbital cellulitis, pus discharge via a subconjunctival sinus in one case and opening of pus pocket in the other case during exploratory orbitotomy confirmed the diagnosis ;,was good in both the cases of cavernous sinus thrombosis, but not in the case due to hypertension. The cases of aneurysms could not be put to surgical treatment.
Metabolic/toxic etiology was a rare cause of ophthalmoplegia. There were 3.2% (2 cases) or diabetes mellitus, one each of painful and painless ophthalmoplegia resulting in VI nerve paralysis. Both cases had poorly controlled diabetes at the time of presentation and showed complete recovery with treatment. One case due to alcoholism showed only partial recovery.