Ординатура / Офтальмология / Английские материалы / Ocular Differential Diagnosis 7th edition_Roy_2002

& Wilkins, 2002.

Chronic Ophthalmoplegia (Slow Onset of Extraocular

Muscle Palsy)

1. Degenerative conditions

A.Amyotrophic lateral sclerosisâ??progressive bulbar palsy

B.Chronic progressive external ophthalmoplegia

C.Hereditary ataxiasâ??Friedreich ataxia, Sangerâ??Brown ataxia

D.Progressive supranuclear palsy

E.Syringomyelia (syringobulbia)

F.Thyroid myopathy (Graves disease)

2. Infective conditions

A.Diffuse sclerosis

B.Disseminated sclerosis (multiple sclerosis)

C.Syphilis

Duke-Elder S, Scott GI. System of ophthalmology, Vol XII. St. Louis: CV Mosby, 1971.

Roy FH. Ocular syndromes and systemic diseases, 3rd ed. Philadelphia: Lippincott Williams & Wilkins, 2002.

Bilateral Complete Ophthalmoplegia (Bilateral Palsy of Ocular Muscles, Ptosis, with Pupil and Accommodation Involvement)

1. Arteriosclerotic hemorrhage and occlusion

2. Cerebellopontine angle tumors (Cushing syndrome II)

3. Encephalitis, acute

4. Fisher syndrome (ophthalmoplegiaâ??ataxia areflexia syndrome)

5. Giant-cell arteritis (Hutchinsonâ??Hortonâ??Magathâ??Brown syndrome)

6. Kilohâ??Nevin syndrome (ocular myeomyopathy)

7. Midbrain tumors

8. Multiple sclerosis (rare)

9. Mucormycosis

10. Ohaha syndrome (ophthalmoplegia, hypotonia, ataxia hypacusis, athetosis)

11. Orbital abscess

12. Parinaud syndrome (conjunctiva-adenitis syndrome)

13. Retrobulbar block complication

14. Rochonâ??Duvigneaud syndrome (superior orbital fissure syndrome)

15. Rollet syndrome (orbital apex-sphenoidal syndrome)

16. Syphilis (acquired lues)

17. Trauma

18. Wernicke encephalopathies (thiamine deficiency)

19. Whipple disease (intestinal lipodystrophy)

Kaufman LM, et al. Invasive sinonasal polyps causing ophthalmoplegia, exophthalmos, and visual field loss. Ophthalmology 1989;96:1667â??1672.Bibliographic Links

McKusick VA. Mendelian Inheritance in Man, 12th ed. Baltimore: Johns Hopkins Hospital Press, 1998.

P.172

Roy FH. Ocular syndromes and systemic diseases, 3rd ed. Philadelphia: Lippincott Williams & Wilkins, 2002.

Sergott RC, et al. Simultaneous, bilateral diabetic ophthalmoplegia. Ophthalmology 1984;91:18â??22.Bibliographic Links

External Ophthalmoplegia (Paralysis of Ocular Muscles Including Ptosis with Sparing of Pupil and Accommodation)

1. Abiotrophyâ??specific for one particular tissue, bilateral, symmetric

2. Amyloidosis (Lubarschâ??Pick syndrome)

3. Aneurysm of internal carotid artery (foramen lacerum syndrome) 4. Bassenâ??Kornzweig syndrome (familial hypolipoproteinemia) 5. Bee sting

6. Chronic progressive external ophthalmoplegia

7. Congenital and familial

8. Diabetes mellitus (Willis disease)

9. Diphtheria

10. Epidemic encephalitis

11. Friedreich ataxia

12. Garcin syndrome (Schmincke tumor unilateral cranial paralysis)

13. Graves disease (hyperthyroidism)

14. Jacod syndrome (petrosphenoidal space syndrome)

15. Kearnsâ??Sayre syndrome (ophthalmoplegic retinal degeneration syndrome)

16. Mumps

17. Myasthenia gravis (Erbâ??Goldflam syndrome)

18. Myotonic dystrophy (Curschmannâ??Steinert syndrome)

19. Myositis

20. Nevus sebaceous of Jadassohn

21. Nothnagel syndrome (ophthalmoplegia-cerebellar ataxia syndrome)

22. Oculopharyngeal syndrome (progressive muscular dystrophy with ptosis and dysphagia) 23. Olivopontocerebellar atrophy III (with retinal degeneration)â??dominant

24. Ophthalmoplegia, progressive external, and scoliosis (horizontal gaze paralysis, familial)â??recessive

25. Pernicious anemia

26. Polyradiculoneuronitis (Guillainâ??Barré and Fisher syndromes)

27. Progressive facial hemiatrophy (Parryâ??Romberg syndrome)

28. Pseudotumor (orbital)

29. Refsum syndrome (heredopathia atactica polyneuritiformis syndrome)

30. Scleroderma (progressive systemic sclerosis)

31. Shyâ??Drager syndrome (orthostatic hypotension syndrome)

32. Shyâ??Gonatas syndrome (accumulation of lipids in muscles simulates gargoylism) 33. Tick paralysis (Lyme disease, Rocky Mountain spotted fever)

34. Vincristineâ??may have fifth and seventh nerve and peripheral neuropathies 35. Wernicke encephalopathies (beriberi, thiamine deficiency)

Fassati A, et al. Chronic progressive external ophthalmoplegia: a correlative study of quantitative molecular data and histochemical and biochemical profile. J Neurol Sci 1994;123:140â??146.Bibliographic Links

Marsch SC, Schaefer HG. External ophthalmoplegia after total intravenous anaesthesia. Anaesthesia 1994;49:525â??527.Bibliographic Links

McKusick VA. Mendelian inheritance in man, 12th ed. Baltimore: Johns Hopkins University Press, 1998.

Roy FH. Ocular syndromes and systemic diseases, 3rd ed. Philadelphia: Lippincott Williams & Wilkins, 2002.

P.173

Internuclear Ophthalmoplegia

This condition comprises paralysis of the medial rectus muscles on attempted conjugate lateral gaze without other evidence of third nerve paralysis due to involvement of medial longitudinal fasciculus. Jerk nystagmus of abducting eye and vertical nystagmus, usually on upward gaze, may be present.

1. Bilateral

A. Arnoldâ??Chiari malformation (cerebellomedullary malformation syndrome)

B.â??Crackâ? cocaine

C.Fabry disease (glycosphingolipid lipidosis)

D.Inflammation, such as upper respiratory infection

E.Midbrain infarction

F.*Multiple sclerosis (disseminated sclerosis)

G.Myasthenia gravis (Erbâ??Goldflam syndrome)

H.Occlusive vascular disease

I.Oculocerebellar tegmental syndrome

J.Pontine hematoma

K.Syphilis (acquired lues)

L.Temporal arteritis

M.Vertebral basilar artery syndrome (whiplash injury)

N.Webino syndrome (wall-eyed exotropia bilateral internuclear ophthalmoplegia)

O.Wernicke encephalopathy

2. Unilateral

A.Bielschowskyâ??Lutzâ??Cogan syndrome (internuclear ophthalmoplegia)

B.Cryptococcosis (torulosis)

C.Multiple sclerosis (disseminated sclerosis)

D.Myasthenia gravis (Erbâ??Goldflam syndrome)

E.Neuro-Behçet Disease

F.Tumors of the brainstem

G.*Vascular lesionâ??infarct of small branch of basilar artery

Atabay C, et al. Eales disease with internuclear ophthalmoplegia. Ann Ophthalmol 1992;24:267â??269.Bibliographic Links

Glaser JS. Neuro-ophthalmology, 3rd ed. Philadelphia: JB Lippincott, 1990.

Okuda B, et al. Bilateral internuclear ophthalmoplegia, ataxia, and tremor from a midbrain infarction. Stroke 1993;24:481â??482.Bibliographic Links

Zee DS. Internuclear ophthalmoplegia: pathophysiology and diagnosis. Baillieres Clin Neurol 1992;1:455â??470.Bibliographic Links

Painful Ophthalmoplegia (Palsy of Ocular Muscles with Pain)

1. Adenocarcinoma metastatic to the orbit

2. Atypical facial neuralgia

3. Cavernous sinus syndrome (Foix syndrome)

4. Collier sphenoidal palsy

5. Diabetic ophthalmoplegia

6. Intracavernous carotid aneurysm

7. Myositis (orbital)

8. Nasopharyngeal tumor

9. Ophthalmoplegic migraine

10. Orbital abscess (mucormycosis-diabetes, immunosuppressed, AIDS)

11. Orbital apex sphenoidal syndrome (Rollet syndrome) P.174

P.175

P.176

12. Orbital periostitis

13. Postherpetic neuralgia

14. Pseudotumor of orbit

15. Superior orbital fissure syndrome (Rochonâ??Duvigneaud syndrome, including superior orbital fissuritis)

16. Temporal arteritis

17. Tic douloureux of the first trigeminal division

18. Tolosaâ??Hunt syndrome (inflammatory lesion of cavernous sinus)

Diagnostic tables

Internuclear ophthalmoplegia

View Table

Painful ophthalmoplegia

View Table

Mannor GE, et al. Outcome of orbital myositis. Ophthalmology 1997;104:409â??414.Bibliographic Links

Roy FH. Ocular syndromes and systemic diseases, 3rd ed. Philadelphia: Lippincott Williams & Wilkins, 2002.

Sananman ML, Weintroub MI. Remitting ophthalmoplegia due to rhabdomyosarcoma. Arch Ophthalmol 1971;86:6:459â??461.

Transient Ophthalmoplegia (Extraocular Muscle Paralysis of

Short Duration)

1. Cranial irradiation and intrathecal chemotherapy

2. Cyclic esotropia

3. Cyclic oculomotor palsy

4. Following internal carotid artery ligation for treatment of intracavernous giant aneurysm 5. Lethargic encephalitis

6. Multiple sclerosis (disseminated sclerosisâ??usually the lateral rectus)

7. Myasthenia gravis (ocular, early)

8. Oculomotor nuclear complex infarction

9. Ophthalmoplegia migraine

10. Post lumbar puncture abducens palsy

11. Syphilis (acquired lues)

12. Tabes dorsalis

13. Treatment of arteriovenous fistulas with Debrun balloon technique 14. Wilson disease (hepatolenticular degeneration)

Gadoth N, Liel Y. Transient external ophthalmoplegia in Wilson's disease. Metab Pediatr. Ophthalmol 1980; 4:71â??72.

Lepore FE, Nissenblatt MJ. Bilateral internuclear ophthalmoplegia after intrathecal chemotherapy and cranial irradiation. Am J Ophthalmol 1981;92:851â??853.Bibliographic Links

Nakao S, et al. Transient ophthalmoplegia following internal carotid artery ligation for treatment of intracavernous giant aneurysm. Surg Neurol 1982;17:458â??463.Bibliographic Links

Painful Ocular Movements (Pain with Movement of the Eyes)

1. Bone-break fever (dengue fever) (rare)

2. Influenza

3. Myositis

A.â??Collagen diseasesâ?

B.Infectious myositis

C.Trichinosis

P.177

4. Orbital cellulitis

5. Orbital periostitis

6. Retrobulbar neuritis

Jampel RS, Fells P. Monocular elevation paresis caused by a central nervous system lesion. Arch Ophthalmol 1968;80:45.Bibliographic Links

Poor Convergence (Inability of Both Eyes to Fixate Simultaneously on a Near Object)

1. Functional

A.Convergence insufficiency

B.Exophoria

C.Exotropia

D.Hysteria

E. Poor attention span 2. Organic

A.Brain lesion, to include bilateral occipital lobe lesions, superior colliculi, and anterior internuclear ophthalmoplegia, such as in hemorrhage, trauma, or tumors

B.Dorsal midbrain syndrome

C.Encephalitis

D.Exophthalmic goiterâ??Möbius sign

E.Exophthalmos

F.Multiple sclerosis

G.Myotonic dystrophy

H.Narcolepsy

I.Poor visual acuity in one or both eyes

J.Postencephalitis

K.Syphilis and tabes

L.Third nerve paralysis (see p. 153)

M.Whiplash injury