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

By: Bel Marra Health | Eye Health | Wednesday, April 05, 2017 - 05:00 AM

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 eye in place.

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 impacts lateral eye movement and often leads to double vision.

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. Generally speaking, medical research suggests that it is 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:

Signs and symptoms of ophthalmoplegia

Eye muscle weakness can occur for a number of 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.

Ophthalmoplegia: Risk factors and complications

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. As mentioned earlier, 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 is important to maintain good vascular health through a balanced lifestyle because it can lower the risk of vision problems.

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 is important to seek medical attention.

Diagnosis and treatment of ophthalmoplegia

When dealing with a diagnosis of ophthalmoplegia, the key is identifying the possible causes of the condition. In the case of internal ophthalmoplegia, an MRI of the brainstem may be able to identify lesions that could cause the symptoms. Additionally, venereal disease research lab testing, which is a special diagnostic test, can identify the presence of syphilis. A test for Lyme disease can also be conducted.

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

Ophthalmoplegia treatment in cases of INO focus 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 is 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.

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