Indian Journal of Ophthalmology

: 1971  |  Volume : 19  |  Issue : 1  |  Page : 38--39

Oculomotor nerve paralysis of unknown aetiology

KK Gupta, RP Kulshrestha 
 Department of Ophthalmology, G. S. V M. Medical College, Kanpur, India

Correspondence Address:
K K Gupta
Department of Ophthalmology, G. S. V M. Medical College, Kanpur

How to cite this article:
Gupta K K, Kulshrestha R P. Oculomotor nerve paralysis of unknown aetiology.Indian J Ophthalmol 1971;19:38-39

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Gupta K K, Kulshrestha R P. Oculomotor nerve paralysis of unknown aetiology. Indian J Ophthalmol [serial online] 1971 [cited 2024 Feb 27 ];19:38-39
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Ophthalmologists, very fre�quently, are called upon to give their opinion and treat cases of solitary oculomotor nerve para�lysis. These cases often have no other neurological deficit and they suffer only from complete or par�tial 3rd cranial nerve paralysis. Commonly the oculomotor nervee paralysis is caused by trauma, in�tracranial haemorrhage, cerebral�oedema, tumours, aneurysms and thrombosis or occlusion of nutri�ent vessels besides various types of neuritis. In certain percentage of cases the exact pathology is not clear. Some type of virus or toxic neuritis may occur in a number of patients at the same time in cer�tain areas.

The present study records a group of III nerve paralysis cases presenting almost similar symp�toms and signs and in all cases the exact aetiological factor was obscure.


1. A. J. T., C. M., 65: Developed pain in right lateral eyebrow and right side of forehead and next morning his eye was closed. There was pain in the eye and swelling of both lids


There was complete ptosis of Right lid without any elevation of it. The Right Eye ball was slightly prominent and laterally displaced with only abduction present.

Pupil reacted briskly. Diplopia was present in the field of action of muscles supplied by the III nerve.


2. R. D. S., H. M., 49: Developed pain in left frontal region eyebrow and eyelid. He developed vomit�ing after 4 days and his eye got closed. On examination was found ptosis, movements of the left eye ball were restricted upwards, downwards and inwards. Diplopia was present in all directions except in the left field. Pupillary reactions were normal.

3. O. P., H. M., 35: Noticed pain in left eyebrow, eyelid and left side of face. On the next day his eye had become closed. All ocular movements were normal and the pupil reacted briskly.

4. A. R., H. M., 25: Got severe pain in the left eye, and left eye�brow. On the same day he noticed diplopia and later on his eyelid drooped down. There was ptosis of the left eye and movements of the eyeball were, restricted up._ wards, downwards and inwards.

5. G., H. F., 36: Developed droop�ing of the upper right eyelid headache, pain in tempeoral region and pain in the right eye. He developed ptosis of the Right Eye, Restriction of eye movements in upward, downward and inward directions and there was diplopia in the corresponding fields.


These five cases of III nerve paralysis (external ophthalmo�plegia) came within an interval of 3 - 4 days and all of sudden on�set. They all presented with ptos�is, restricted movements of the eyeball without pupillary involve�ment. In all cases it started with severe headache and pain in and around the eye. Vision and the fundi oculi were normal in all of them.

The routine investigations of blood picture, urine examination. X-ray skull, and V D R L were negative though the ESR was raised in all cases - 45, 42, 37, 21 and 35 mm. for first hour respectively.

In the absence of definite aetio�logy they were given oral steroids and tetracyclines for periods from 10-25 days resulting in complete recovery of function within four weeks except in one case where complete recovery oc�cured in nine weeks time.


The exact diagnosis of the cases of oculomotor nerve paralysis may not be possible in all the cases. Rucker [1],[2] failed to find out the causes of III nerve paralysis in 28% of cases in his series of 95 cases. In the present report 5 cases came to the hospital within a short time of 3-4 days with al�most common presenting sympto�ms and signs which may be attri�buted to some form of toxic neu�ritis or viral neuritis. In the ab�sense of suggestion of any toxic medication etc., it is more likely that these cases may be of a viral neuritis type.


Five cases of III cranial nerve paralysis probably due to viral neurities admitted in the Hospital within a interval of 3-4 days are reported. The exact etiology could not be confirmed, but complete recovery took place after steroid and antibiotic therapy.


1RUCKER, C. W.: (1950): Paralysis of the III, 4th and 6th cranial nerves. Am. J. Oph. 46:787 - 794.
2KIEFE, W. P.: RUCKER, C. W.: and KERNOHAN, J. W. (1960). Patho�genesis of paralysis of 3rd nerve. M. A. Arch. Ophth. 63:585 - 92.