Etiology
Adults:
-Diabetes
-Hypertension
-Atherosclerotic
-Trauma
-Idiopathic
Children:
-Post viral infection
-Gradenigo's syn
-Pontine glioma
-Trauma
Predisposing Factors
Non-localizing causes
-Increased CSF Pressure
-Head trauma
-Hypertension, Diabetes (pupil sparing)
-Lumbar puncture, Basilar meningitis
-Post infection ( middle ear )
- Wernicke's encephalopathy (alcoholism)
Localizing causes
-Pontine syndrome (Contralateral hemiplegia, Ipslateral Facial N. plasy, Horizontal gaze palsy,)
-+/- Internuclear ophthalmoplegia, Cerebellar-Pontine angle syn.( VIII,VII,VI,Nystagmus, cerebellar Middle fossa disorder)
-Clivus- (Nasopharyngeal Ca, Chordoma)
-Cavernous Sinus /Superior Fissure Syn., \Carotid-Cavernous sinus A:V Fistula
Symptoms
-Diplopia
- Binocular Horizontal (image side by side)
-Diplopia worst at distance than near more pronounced diplopia in field of action of the involved muscle
Signs
-Involved eye does not move outward, Eso-deviation of involved eye
-Abduction limited 0Diplopia worst at distance than near
-Horizontal uncrossed diplopia (greater on gaze toward the involved side)
-Head turn toward the involved side to eliminate diplopia
-No restriction on forced duction 0No proptosis
Differential Diagnosis
Myasthenia gravis -no pain, Graves myopathy, Orbital Trauma, Congenital defect
Duane's Clinical Ophthalmology