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A Clinical and Aetiological Study of Ocular Motor Nerve Palsy

Renu Shukla Dubey , Lolla Ramachandra Murthy1 , Renu Shukla Dubey2

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Ophthalmology and Allied Sciences 5(1):p 45-49, January-April 2019. | DOI: DOI: http://dx.doi.org/10.21088/oas.2454.7816.5119.8

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Abstract

 Aim: To clinically evaluate cases of ocular motor nerve palsy and to diagnose their possible aetiological causes as they are often perceived as a sign of serious underlying pathology such as intracranial aneurysms. Purpose: To clinically evaluate cases of ocular motor nerve palsy so as to make anatomical localization and also to make possible aetiological and pathological diagnosis of the neurological lesion. Anatomical localization and aetiopathological diagnosis of the neurological lesion will help the attending neurologist in better management of the case. Introduction: Ocular motor nerve palsies may be congenital or acquired, complete or partial, pupil sparing or pupil involving, and isolated or multiple accompanied by signs of more extensive neurological involvement. Precise knowledge of its origin and course from nuclear level to terminal muscles along with associated clinical features helps in localization and management of neurological lesions. Materials And Methods: 50 consecutive cases of ocular motor nerve palsy attending the outpatient clinic of the department of ophthalmology Malla Reddy Hospital, Malla Reddy Institute of Medical Sciences or referred from other specialties are evaluated and investigated thoroughly as a Prospective, observational, non – interventional and Hospital study study from 1st January 2018 to 31st December 2018. All underwent complete ophthalmological, medical, neurological, otorhinolaryngological and general examination along with complimentary investigations and neuroradiological imaging where ever possible. Inclusion Criteria: Acquired ocular motor nerve palsy with a recent onset (within two weeks), all age groups and both sexes included, ocular motor nerve palsies associated with other neurological signs and symptoms other than the palsy itself and acceptance of the patients to undergo investigations wherever needed. Exclusion Criteria: Congenital ocular motor nerve palsy, patients with incomitant squint due to myogenic, myasthenic and restrictive causes, patients who were terminally ill and those palsies secondary to neurosurgical causes were excluded from the study. Results: Paralyses of the sixth and third cranial nerve were the most common. Complete ptosis and full mydriasis were mostly seen in isolated cases of third carnial nerve palsy. Majority of them are pupil sparing. Common causes were vascular, otorhinolaryngological and trauma. Micro vascular ischemia group as an aetiological factor has good recovery rate and so is the case with pupil sparing oculomotor nerve palsy. Conclusion: Proper evaluation of cases of ocular motor nerve palsy in close collaboration with other specialists will go a long way not only in localizing the serious neurological lesion and also help in reducing the mortality, morbidity and better management of ocular motility disorder.

Keywords: Isolated Ocular Motor Nerve Palsy; Pupillary Sparing Microvascular Ischemia.

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DOI: DOI: http://dx.doi.org/10.21088/oas.2454.7816.5119.8

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