OVERVIEW
Overview of the Oculomotor Nerve
The three pairs of cerebral nerves, the motoneurons, the gliding and the abducens, are the motor nerves of the eye muscles. It is customary to refer to these three pairs as the oculomotor nerves, and the three form a functional unit, so that the three are more often than not discussed together in the narrative.
Whether medical insurance
Yes
Department
Ophthalmology, Neurology, Neurosurgery, Medical Oncology, Surgical Oncology, Endocrinology
Clinical symptoms
Clinically visible eye movement disorder and abnormal pupil dilation function.
Hazards
This disease can affect the patient’s normal life and work due to paralysis of eye muscles.
Examination
Ophthalmologic examination, blood glucose test, digital subtraction angiography, head CT, cranial MRI, etc.
Diagnosis
This disease should be considered when eye movement disorder and pupil dilation function are abnormal. Clinical history and imaging and other auxiliary examinations should be combined to determine the location and etiology of the lesion.
Treatment principle
Treatment should be directed at the cause of the disease, such as anti-infection and surgical removal of the tumor.
Curability
Symptoms may improve after treatment.
Dietary advice
Eat a reasonable diet, consume more fresh fruits and vegetables, avoid smoking and alcohol.
Etiology
Etiology
The disease is associated with head trauma, brain tumors, vascular lesions, infections and other diseases. Cerebral arteriosclerotic vascular disease can often occur suddenly due to vascular obstruction, compression or hemorrhage of the eye muscle paralysis. Diabetes mellitus can be complicated by diabetic ischemic lesions. A small number of migraineurs develop ipsilateral pupil dilation and extraocular muscle paralysis of varying degrees during or after a migraine attack. Ocular myotonic dystrophy is a rare hereditary disease that can result in total paralysis of the extraocular muscles. Ocular muscle paralysis can occur in congenital ptosis and intraorbital pseudotumor. Hyperthyroidism or pituitary deficiency can also produce paralysis of the eye muscles and proptosis.
Symptoms and Diagnosis
Typical Symptoms
Ocular dyskinesia and abnormal pupillary dilation occur with damage to the motor, gliding, and abducens nerves. There are four types of oculomotor disorders: peripheral, nuclear, internuclear and supranuclear. (1) Peripheral ophthalmoplegia: When the motor nerve is paralyzed, there may be ptosis, exotropia, diplopia, pupil dilatation, loss of light emission and modulation emission, and limitation of upward, downward, and inward movement of the eyeball. In gliding nerve palsy, downward and outward movements of the affected eye are diminished and diplopia is present; isolated gliding nerve palsy is rare. In abducens nerve palsy, there is inward strabismus, limited outward eye movement, and diplopia. Combined palsy of the motor, gliding and abducens nerves is common, which is characterized by limitation of eye movement in all directions with fixation in the middle position, pupil dilatation, and loss of photopic and accommodative emissions. (2) Nuclear oculomotor palsy: it is often accompanied by damage to adjacent nerve tissues, and selectively impairs only part of the ocular muscle function. (3) Internuclear oculomotor palsy: If the lesion affects the medial longitudinal fasciculus, the horizontal isotropic movement of the eyeball will be destroyed, and it is common that one side of the eyeball has normal abduction, while the other side of the eyeball can’t retract inward at the same time. (4) Supranuclear oculomotor palsy: it can produce simultaneous deviation of both eyes, and the most common types are simultaneous gaze palsy and simultaneous vertical movement palsy.
Diagnostic basis
This disease should be considered when there are symptoms such as eye movement disorder and pupil dilation function abnormality, and clinical history and imaging and other auxiliary examinations should be combined to determine the location and etiology of the lesion.
Treatment
Treatment
Treatment should be tailored to the cause of the disease. If the disease is caused by infection, antibiotics and other medications should be given. Tumors and trauma can be treated with surgery. For diabetic oculomotor paralysis, active blood sugar control is necessary.
Drug treatment
1. Ophthalmoplegia caused by infectious diseases should be treated with high-dose antibiotics. 2. Ophthalmoplegia caused by painful ophthalmoplegia, brainstem encephalitis, traumatic brain injury or meningitis, etc., and a larger dose of antibiotics is advocated in the early stage of the disease. 3. Ophthalmoplegia caused by brainstem infarction can be treated with bulking agents, cerebral metabolism accelerators, and calcium channel blockers. 4. Ophthalmoplegia accompanied by increased intracranial pressure may be treated with dehydration. 5. Surgical treatment
Surgical treatment
1. eye muscle paralysis caused by cerebral aneurysm should be surgically treated by ligating the aneurysm. 2. traumatic eye muscle paralysis is treated with corresponding surgery.
Prognosis
Symptoms may improve after treatment.
Nursing care
Daily care
1. Keep the environment quiet and clean, the indoor air is fresh, open the windows regularly for ventilation. 2. Pay attention to rest, ensure enough sleep, avoid physical and mental fatigue and overuse of eyes. 3. Adhere to the medication prescribed by the doctor, and do not increase or decrease the dosage or stop the medication on your own. 4. Regularly review the medication, and go to the hospital for treatment if there is any discomfort.
Diet
Reasonable diet, choose light, easy to digest, low-fat, high-protein, vitamin-rich diet, eat more fresh fruits and dark green vegetables, avoid greasy, spicy food, avoid smoking and alcohol.