Ophthalmoplegia (eye muscle weakness): Causes, signs, and treatment

ophthalmoplegiaOphthalmoplegia or eye muscle weakness is a condition that is characterized by either paralysis or weakness of the eye muscles. It can lead to a lack of eye mobility and even permanent eye drooping, since it can affect one or more of the six muscles that hold the eyes in place.

Types of Ophthalmoplegia

There are two different types of ophthalmoplegia: chronic progressive external ophthalmoplegia and internal ophthalmoplegia (INO).


Chronic progressive ophthalmoplegia or PEO tends to appear in adults between the ages of 18 and 40. Usually, it starts with drooping eyelids and difficulty controlling muscles that are normally used to coordinate the eyes.

Internal ophthalmoplegia (INO) affects lateral eye movement and often leads to double vision or rapid involuntary motion (strabismus). INO is caused by damage to the medial longitudinal fasciculus, which is a bunch of nerve cells that lead to the brain. INO is very rare in children and most commonly seen among in young adults and seniors.

What Causes Muscle Weakness in the Eye?

Ophthalmoplegia causes vary from person-to-person and can be associated with muscle disorders, thyroid issues, stroke, and other neurological problems – or, you could be born with it. Medical research suggests that it’s due to a disruption of messages that are sent from the brain to the eyes.

Internal ophthalmoplegia has been linked to multiple sclerosis, trauma, and infarction, while mitochondrial diseases – including Graves’ disease or Kearns-Sayre syndrome – can cause external ophthalmoplegia. Below are some other potential causes:

  • Thyroid disease
  • Migraines
  • Brain tumor
  • Brain injury
  • Infection
  • Diabetes

Signs and Symptoms of Ophthalmoplegia

Eye muscle weakness can occur for several reasons, so it doesn’t necessarily mean you have ophthalmoplegia. For instance, some drugs come with side effects that can produce weakness in the eye muscle. Antidepressants and phenothiazine, which are used to treat serious mental and emotional disorders, can lead to eye muscle weakness.

Here are some of the initial signs and symptoms of ophthalmoplegia:

  • Difficulty moving the eye
  • Eye pain and/or headaches
  • Ptosis, which is the drooping of the eye
  • Decreased peripheral vision

People who are born with ophthalmoplegia often find that it advances to the point where they experience double vision along with some of the symptoms mentioned above.

Risk Factors of Ophthalmoplegia

Research into ophthalmoplegia is ongoing, but we can tell you that diabetes appears to be a risk factor for this condition. Men over the age of 45 who have suffered from type-2 diabetes for over 10 years have been identified as having a higher risk of getting ophthalmoplegia. Individuals that have muscle control problems such as MS or Graves’ disease are also at a higher risk.

To date, research suggests that there are no lifestyle factors that increase the risk of ophthalmoplegia. It’s important to maintain good vascular health through a balanced lifestyle because it can lower the risk of vision problems.

Complications of Ophthalmoplegia

People who suffer from ophthalmoplegia are usually seen by a doctor on a regular basis. There is potential for muscle control to lessen over time. When blurred vision, double vision, or a sudden increase in headaches or dizziness occur, it’s important to seek medical attention.

Diagnosing Eye Muscle Weakness

When dealing with a diagnosis of ophthalmoplegia, the key is identifying the possible causes of the condition. MRI or CT scans may be used to obtain detailed images of the eye. Blood tests are also necessary to determine underlying causes like a thyroid disease, which could affect the eyes and vision.

Some patients may be sent to a neurologist or other type of specialist depending on test results.

Anyone who presents with ophthalmoplegia signs and symptoms is likely to have their blood pressure measured. If you’re a post-stroke patient, this is a given.

Treatment Methods of Ophthalmoplegia

Ophthalmoplegia treatment in cases of INO focuses on managing the cause so the communication between the cranial nerves and medial rectus fasciculus improves. Medial and rectus fasciculus are fibers in the brainstem that help control eye movement. Surgery can be performed in some cases to remove brainstem lesions that are causing INO. There are some situations where the condition is caused by infections, Lyme disease, or syphilis, which can be treated with antibiotics and antiviral therapies. Patients find that once the underlying condition improves, so does the ophthalmoplegia.

In terms of external ophthalmoplegia, it’s worth noting that some studies have indicated improvement in patients treated with CoQ10. In these cases, a decrease in serum levels of pyruvate and lactate were observed, along with a general improvement in brain function.

Some patients experience advanced drooping or ptosis and can be treated with adhesive tape and lid crutches. There is also a procedure using what is known as a silicone sling to help elevate a drooping eye.

Having a droopy eye may not sound serious, and in some cases, that is true. However, when muscle weakness in the eye doesn’t seem to go away, it should be checked out by a qualified healthcare professional. If the diagnosis ends up being ophthalmoplegia, fast treatment could mean slowing the progression of the condition and preventing more serious complications such as blurred or double vision.

Exercises to Strengthen Eye Muscles

Your eyes have muscles like the rest of your body which means they require exercise to boost circulation and strength. Incorporating eye exercises into your daily routine may help improve muscle weakness, which may help them work more efficiently. It’s important to note that eye exercises are a cure but do have the potential to improve the eyes.

Here are some eye exercises you can try:

Eye circles: While keeping your eyes open, slowly rotate them in a circular motion. Do these 20 times and then rest for 10 seconds. Repeat this counterclockwise. If this is uncomfortable, then it can be performed with your eyes closed until you feel comfortable doing this with your eyes open. Perform this three times a day.

Moving pen focus: Sit upright on a chair while holding a pen with your right hand straight in front of your body. Focus on the pen’s tip for about 10 seconds and then begin to slowly bring the pen closer to your nose while maintaining focus. Once closest to your nose, focus on the tip for another five second then slowly bring the pen away from your face once again. Once this is complete, rest for 10 seconds and perform this two more times.

Immobile face focus: Sit upright in a chair and lower your gaze to the tip of your nose. Breathe normally. Avoid blinking as you hold this stare for about 15 seconds. Slowly return your eyes to original position. Close your eyes and relax for 20 seconds. When you open your eyes again, turn your gaze upwards to the middle of your eyebrows. Hold for 20 seconds then return back to normal. Quickly blink for 10 seconds then close your eyes for 20 seconds. Repeat a few times alternating from a downward to upward gaze.

Eye contractions: Sitting in a chair, place your palms on your lap facing upward and place your feet firmly on the floor. Tightly contract your eye muscles by closing and squeezing them. Hold this for four second, release, and rapidly blink 15 times. Relax for five seconds and repeat five times throughout the day.


Vertical maneuvers: Sit in a chair and look up to the ceiling. Hold this gaze for five seconds before returning back to normal for six seconds. Blink quickly for 10 seconds then relax for 20 seconds. Repeat four times.

Incorporating these exercises into your daily routine may aid in the functionality of your eyes and cause them to become stronger. Person’s living with ophthalmoplegia have a positive prognosis and can live a normal life, but this is largely based on the underlying cause. If ophthalmoplegia is diagnosed early on prognosis improves and there is a reduced risk of complications.

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Author Bio

Emily Lunardo studied medical sociology at York University with a strong focus on the social determinants of health and mental illness. She is a registered Zumba instructor, as well as a Canfit Pro trainer, who teaches fitness classes on a weekly basis. Emily practices healthy habits in her own life as well as helps others with their own personal health goals. Emily joined Bel Marra Health as a health writer in 2013.



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