Ophthalmoplegia: paralysis of the eye muscles

Ophthalmoplegia is the total or partial paralysis of the muscles that move the eye. The patient notices it as one eye not tracking with the other, difficulty looking to one side, double vision (diplopia) or a drooping eyelid. In medicine it is a neurological or orbital sign. In facial harmonization it is a warning sign.

Which muscles are involved?

Six extraocular muscles move each eye, controlled by three cranial nerves (oculomotor, trochlear and abducens). The muscle that lifts the eyelid, the levator palpebrae superioris, receives its command from the oculomotor nerve. When one of these structures is affected, the picture varies according to the muscle involved.

Why does it appear in facial harmonization?

Ophthalmoplegia is on the list of signs the professional must recognize in two contexts.

• Vascular complication: an event reaching the territory of the ophthalmic artery can affect the retina, the eye muscles and the optic nerve. Besides vision loss (amaurosis), there can be limited eye movement and pain. See vascular occlusion and vascular embolism.
• Toxin diffusion: botulinum toxin injected near the orbit can reach eye muscles through diffusion, causing temporary diplopia and ptosis. The effect usually resolves with time, but requires follow-up.

How to tell it apart from other causes?

Many patients have old strabismus, nerve palsy from a systemic disease or prior eyelid asymmetry. That is why the initial assessment should record:

• Eye movement in the nine gaze positions, in a simple way (following the finger up, down and to the sides).
• Eyelid position at rest.
• Prior complaints of double vision, eye surgery and neurological disease.

What does Harmy have to do with this?

Also called: paralysis of the ocular muscles, ophthalmoplegia.