Complex Ophthalmoplegia

 

This essentially refers to an opthalmoplegia that doesn't neatly fit one particular peripheral nerve (e.g. CNIII palsy). I would present it as a "complex opthalmoplegia" and then discuss the differentials using the 'neuroaxis' systematic approach discussed earlier (see initial Read Me page). ​

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Aetiologies:

1. Central - MS (INO), PSP, Parinaud 

2. Nerve: GBS (Miller-Fisher), mononeuritis multiplex

3. NMJ - MG

4. Muscle: thyroid disease (proptosis, lid retraction, lid lag, peri-orbital oedema), mitochondrial diseases, ocular myopathies

 

Grouped ophthalmoplegia

• Cavernous sinus - 3 + 4 + 5 (V1) + 6 + Horners

 

Graves:

• The salient findings were proptosis with lid retraction, peri-orbital oedema, and complex ophthalmoplegia suggestive of Graves eye disease.