oculomotor nerve diseases


Summary: Diseases of the oculomotor nerve or nucleus that result in weakness or paralysis of the superior rectus, inferior rectus, medial rectus, inferior oblique, or levator palpebrae muscles, or impaired parasympathetic innervation to the pupil. With a complete oculomotor palsy, the eyelid will be paralyzed, the eye will be in an abducted and inferior position, and the pupil will be markedly dilated. Commonly associated conditions include neoplasms, CRANIOCEREBRAL TRAUMA, ischemia (especially in association with DIABETES MELLITUS), and aneurysmal compression. (From Adams et al., Principles of Neurology, 6th ed, p270)

Top Publications

  1. Zada G, Pezeshkian P, Giannotta S. Spontaneous intracranial hypotension and immediate improvement following epidural blood patch placement demonstrated by intracranial pressure monitoring. Case report. J Neurosurg. 2007;106:1089-90 pubmed
    ..Intracranial pressure monitoring proved to be useful in the diagnosis and management of SIH in this patient. ..
  2. Cheng C, Lin H, Cho D, Chen C, Liu Y, Chiou S. Intracavernous sinus arachnoid cyst with optic neuropathy. J Clin Neurosci. 2010;17:267-9 pubmed publisher
    ..Visual acuity improved dramatically after the operation. Intracavernous sinus arachnoid cyst is a rare congenital intracranial lesion and surgical decompression may benefit symptomatic patients...
  3. Strupp M, Hüfner K, Sandmann R, Zwergal A, Dieterich M, Jahn K, et al. Central oculomotor disturbances and nystagmus: a window into the brainstem and cerebellum. Dtsch Arztebl Int. 2011;108:197-204 pubmed publisher
    ..DBN is generally due to cerebellar dysfunction, e.g., because of a neurodegenerative disease. This short review focuses on the clinical characteristics, pathophysiology and current treatment of oculomotor disorders and nystagmus. ..
  4. Acaroglu G, Akinci A, Zilelioglu O. Retinopathy in patients with diabetic ophthalmoplegia. Ophthalmologica. 2008;222:225-8 pubmed publisher
    ..028 and p = 0.018, respectively). Presence and level of diabetic retinopathy are significantly lower in diabetics with cranial nerve palsy than in the age-, sex- and disease-duration-matched controls. ..
  5. Tanriover N, Kemerdere R, Kafadar A, Muhammedrezai S, Akar Z. Oculomotor nerve schwannoma located in the oculomotor cistern. Surg Neurol. 2007;67:83-8; discussion 88 pubmed
    ..The chance of occurrence of the nerve palsy may increase as the resection proceeds more anteriorly toward the superior orbital fissure. ..
  6. Itshayek E, Perez Sanchez X, Cohen J, Umansky F, Spektor S. Cavernous hemangioma of the third cranial nerve: case report. Neurosurgery. 2007;61:E653; discussion E653 pubmed
    ..The authors report a rare case of a cavernous hemangioma (CH) involving the third cranial nerve...
  7. Fogel B, Perlman S. Novel mutations in the senataxin DNA/RNA helicase domain in ataxia with oculomotor apraxia 2. Neurology. 2006;67:2083-4 pubmed
  8. Anheim M, Fleury M, Franques J, Moreira M, Delaunoy J, Stoppa Lyonnet D, et al. Clinical and molecular findings of ataxia with oculomotor apraxia type 2 in 4 families. Arch Neurol. 2008;65:958-62 pubmed publisher
  9. Alonso Canovas A, Martinez San Millan J, Novillo López M, Masjuan Vallejo J. [Third cranial nerve palsy due to intracranial hypotension syndrome]. Neurologia. 2008;23:462-5 pubmed
    ..Third CN palsy is an extremely unusual manifestation of IHS and contributes to the expansion of its clinical spectrum. ..

More Information


  1. Bernard V, Stricker S, Kreuz F, Minnerop M, Gillessen Kaesbach G, Zuhlke C. Ataxia with oculomotor apraxia type 2: novel mutations in six patients with juvenile age of onset and elevated serum alpha-fetoprotein. Neuropediatrics. 2008;39:347-50 pubmed publisher
    ..By molecular testing the clinical diagnosis has been confirmed in all patients...
  2. Ashker L, Weinstein J, Dias M, Kanev P, Nguyen D, Bonsall D. Arachnoid cyst causing third cranial nerve palsy manifesting as isolated internal ophthalmoplegia and iris cholinergic supersensitivity. J Neuroophthalmol. 2008;28:192-7 pubmed publisher
    ..Our patient serves as a reminder that isolated internal ophthalmoplegia with cholinergic supersensitivity is compatible with a preganglionic compressive third nerve lesion, particularly in a young child...
  3. Criscuolo C, Chessa L, Di Giandomenico S, Mancini P, Saccà F, Grieco G, et al. Ataxia with oculomotor apraxia type 2: a clinical, pathologic, and genetic study. Neurology. 2006;66:1207-10 pubmed
    ..The identification of new mutations expands the array of SETX variants, and the finding of a missense change outside the helicase domain suggests the existence of at least one more functional region in the N-terminus of senataxin. ..
  4. Kim J, Kim J. Pure midbrain infarction: clinical, radiologic, and pathophysiologic findings. Neurology. 2005;64:1227-32 pubmed
    ..Large vessel disease and small vessel disease are usual pathogenic mechanisms, whereas cardiogenic embolism is rare. ..
  5. Tilikete C, Vighetto A, Trouillas P, Honnorat J. Potential role of anti-GAD antibodies in abnormal eye movements. Ann N Y Acad Sci. 2005;1039:446-54 pubmed
    ..The potential role of antiGAD-Ab and the resultant GABAergic neurotransmission deficit in oculomotor manifestations is discussed. ..
  6. Dimopoulos V, Fountas K, Feltes C, Robinson J, Grigorian A. Literature review regarding the methodology of assessing third nerve paresis associated with non-ruptured posterior communicating artery aneurysms. Neurosurg Rev. 2005;28:256-60 pubmed
    ..Our simple grading system of third nerve palsy associated with P-Com A aneurysms, can be a helpful tool for the initial evaluation and for the monitoring of recovery in these patients. ..
  7. Duquette A, Roddier K, McNabb Baltar J, Gosselin I, St Denis A, Dicaire M, et al. Mutations in senataxin responsible for Quebec cluster of ataxia with neuropathy. Ann Neurol. 2005;57:408-14 pubmed
    ..The study of this large French-Canadian cohort better defines the phenotype of this ataxia and presents two novel mutations in senataxin including the more common founder mutation in the French-Canadian population. ..
  8. Champion B, Choy F, Schrieber L, Roche J, Rowe D. Isolated fascicular oculomotor nerve palsy as the initial presentation of the antiphospholipid syndrome. J Clin Neurosci. 2002;9:691-4 pubmed
    ..Anticoagulation with warfarin was commenced, with gradual resolution of neurological deficits. This case illustrates an unusual initial manifestation of primary antiphospholipid syndrome causing midbrain stroke in a young woman. ..
  9. Brady McCreery K, Speidel S, Hussein M, Coats D. Spontaneous intracranial hypotension with unique strabismus due to third and fourth cranial neuropathies. Binocul Vis Strabismus Q. 2002;17:43-8 pubmed
    ..This is the first reported case in which bilateral trochlear nerve paresis has been reported in association with this condition. ..
  10. Jacobson D. Pupil involvement in patients with diabetes-associated oculomotor nerve palsy. Arch Ophthalmol. 1998;116:723-7 pubmed
    ..To derive a reliable estimate of the frequency of pupil involvement in patients with diabetes-associated oculomotor nerve palsy...
  11. Warner G. Spontaneous intracranial hypotension causing a partial third cranial nerve palsy: a novel observation. Cephalalgia. 2002;22:822-3 pubmed
  12. Mukerji N, Cahill J, Tzerakis N, Nath F, Dervin J. Venous anastomotic circle, multiple varices and oculomotor palsy--a rare coincidence. Acta Neurochir (Wien). 2010;152:2205-9 pubmed publisher
    ..This was treated successfully with Onyx™ injection with a satisfactory angiographic result and complete resolution of symptoms. ..
  13. Ameri A, Jafari A, Anvari F, Rezvan J, Fard M. Simplified use of suture fixation associated with lateral rectus myectomy in management of complete third nerve palsy. J Pediatr Ophthalmol Strabismus. 2010;47 Online:e1-3 pubmed publisher
    ..Three patients underwent this technique. Horizontal alignment was satisfactory postoperatively. ..
  14. Hong G, Yang Z, Chu J, Li S, Zheng S, Zhou Z. Three-dimensional MRI with contrast diagnosis of diseases involving peripheral oculomotor nerve. Clin Imaging. 2012;36:674-9 pubmed publisher
    ..with contrast (3D-CEMRI) in displaying peripheral oculomotor nerve (PON) and diagnosing peripheral oculomotor nerve diseases (POND)...
  15. Gaberel T, Borha A, di Palma C, Emery E. Clipping Versus Coiling in the Management of Posterior Communicating Artery Aneurysms with Third Nerve Palsy: A Systematic Review and Meta-Analysis. World Neurosurg. 2016;87:498-506.e4 pubmed publisher
    ..A randomized trial would better address the therapeutic dilemma, but pending the results of such a trial, we recommend treating PCoA aneurysms causing ONP with surgery. ..
  16. Pletz C. [Steele-Richardson-Olszewski syndrome]. Klin Monbl Augenheilkd. 2007;224:939-42 pubmed publisher
    ..L-Dopa medication has very little or no influence on PSP. At present, however, a certain diagnosis is only possible post-mortem, in spite of helpful clinical diagnostics. ..
  17. Kim J, Hwang J. Imaging of Cranial Nerves III, IV, VI in Congenital Cranial Dysinnervation Disorders. Korean J Ophthalmol. 2017;31:183-193 pubmed publisher
  18. Kang S. Ruptured anterior communicating artery aneurysm causing bilateral oculomotor nerve palsy: a case report. J Korean Med Sci. 2007;22:173-6 pubmed
    ..The patient communicated well with simple words. The author reviewed and discussed the possible mechanism of this rare neuro-ophthalmological manifestation in view of a false localizing sign. ..
  19. Mora J. Periosteal fixation in third nerve palsy. J AAPOS. 2007;11:207; author reply 208 pubmed
  20. Chansoria M, Agrawal A, Ganghoriya P, Raghu Raman B. Pseudotumor cerebri with transient oculomotor palsy. Indian J Pediatr. 2005;72:1047-8 pubmed
    ..We report a unique case of pseudotumor cerebri who had left Oculomotor palsy with sparing of the pupillary fibres, which resolved following treatment with oral acetazolamide. ..
  21. Wang J, Gong X, Sun Y, Hu X. Prevalence of nerve-vessel contact at cisternal segments of the oculomotor nerve in asymptomatic patients evaluated with magnetic resonance images. Chin Med J (Engl). 2010;123:989-92 pubmed
    ..There is no correlation with individual age. Discretion should be used when making an etiological diagnosis of vascular compression for patients with oculomotor nerve palsy. Further investigation of other causes is warranted. ..
  22. Choi K, Hwang J, Park S, Kim J. Primary aberrant regeneration and neuromyotonia of the third cranial nerve. J Neuroophthalmol. 2006;26:248-50 pubmed
    ..Abnormal and excessive conduction triggered by stimulation of a partially damaged nerve probably underlies ocular neuromyotonia. ..
  23. Aluclu M, Keklikci U, Guzel A, Unlu K, Tatli M. Melkersson-Rosenthal syndrome with partial oculomotor nerve palsy. Ann Saudi Med. 2008;28:135-7 pubmed
  24. Graf M, Lorenz B. [Inferior nasal transposition of the lateral rectus muscle for third nerve palsy]. Klin Monbl Augenheilkd. 2010;227:804-8 pubmed publisher
    ..The vertical effect is useful to correct for hypertropia and induce a durable, slightly depressed eye position which is profitable for monocular visual demands and aesthetically appealing. ..
  25. Vaphiades M, Roberson G. Sphenoid sinus mucocele presenting as a third cranial nerve palsy. J Neuroophthalmol. 2005;25:293-4 pubmed
    ..A 90-year-old woman developed an acute left third cranial nerve palsy. Brain imaging revealed a left sphenoid sinus mucocele. Endoscopic marsupialization of the mucocele led to complete resolution of the third cranial nerve palsy...
  26. Keane J. Third nerve palsy: analysis of 1400 personally-examined inpatients. Can J Neurol Sci. 2010;37:662-70 pubmed
    ..Few cases remained undiagnosed and nondiabetic ischemia was rare. ..
  27. Oohira A, Furuya T. Ocular neuromyotonia with spastic lid closure. J Neuroophthalmol. 2006;26:244-7 pubmed
    ..Ephaptic transmission in a damaged third cranial nerve may be responsible for the neuromyotonia and synkinesis. Synkinesis is a more enduring manifestation. ..
  28. Appenzeller S, Veilleux M, Clarke A. Third cranial nerve palsy or pseudo 3rd nerve palsy of myasthenia gravis? A challenging diagnosis in systemic lupus erythematosus. Lupus. 2009;18:836-40 pubmed publisher
    ..We report a case of a patient with longstanding quiescent SLE who presented with sudden onset of diplopia and discuss possible aetiologies including ischemia, demyelination, neuromuscular conditions and medication-induced. ..
  29. Saetia K, Larbcharoensub N, Wetchagama N. Oculomotor nerve schwannoma: a case report and review of the literature. J Med Assoc Thai. 2011;94:1002-7 pubmed
    ..Therefore, a subtotal removal of large oculomotor schwannoma followed by stereotactic radiotherapy could provide a safer alternative compared to radical surgery. ..
  30. Sharma P, Gogoi M, Kedar S, Bhola R. Periosteal fixation in third-nerve palsy. J AAPOS. 2006;10:324-7 pubmed
    ..We present a new technique of anchoring the eyeball to the nasal periosteum using a nonabsorbable suture in acquired isolated third-nerve paresis...
  31. Yonghong J, Kanxing Z, Wei L, Xiao W, Jinghui W, Fanghua Z. Surgical management of large-angle incomitant strabismus in patients with oculomotor nerve palsy. J AAPOS. 2008;12:49-53 pubmed
    ..By choosing the appropriate surgical procedure, eye alignment in the primary position was achieved, but recurrence of the exotropia was unavoidable, and a residual exotropia of 10(Delta) to 20(Delta) remained in most patients. ..
  32. Ela Dalman N, Arnold A, Chang L, Velez F, Lasky J. Abducens nerve ocular neuromyotonia following non-sellar or parasellar tumors. Strabismus. 2007;15:149-51 pubmed
    ..We report two unusual cases of abducens nerve ocular neuromyotonia that followed radiation therapy of tumors in areas other than the sellar or parasellar region. ..
  33. Kawamoto S, Matsuda H, Ueki K, Okada Y, Kim P. Neuromuscular choristoma of the oculomotor nerve: case report. Neurosurgery. 2007;60:E777-8; discussion E778 pubmed
    ..NMC may need histological confirmation for diagnosis if they occur in the intracranial space. The resection is feasible, and the function of the affected nerve can be at least partially restored with the nerve reconstruction. ..
  34. Elmalem V, Hudgins P, Bruce B, Newman N, Biousse V. Underdiagnosis of posterior communicating artery aneurysm in noninvasive brain vascular studies. J Neuroophthalmol. 2011;31:103-9 pubmed publisher
  35. Muthukumar N, Senthilbabu S, Usharani K. Idiopathic hypertrophic cranial pachymeningitis masquerading as Tolosa-Hunt syndrome. J Clin Neurosci. 2005;12:589-92 pubmed
    ..Tolosa-Hunt syndrome might represent a focal manifestation of Idiopathic hypertrophic cranial pachymeningitis. Future studies are necessary to further clarify the relationship between these two conditions. ..
  36. Wykoff C, Lam B, Brathwaite C, Biegel J, McKeown C, Rosenblum M, et al. Atypical teratoid/rhabdoid tumor arising from the third cranial nerve. J Neuroophthalmol. 2008;28:207-11 pubmed publisher
    ..Despite aggressive chemotherapy, the patient died within 6 months of presentation. This is the first report of an AT/RT presenting as an isolated third cranial nerve palsy caused by tumor arising from within the nerve...
  37. Fleseriu M, Lee M, Pineyro M, Skugor M, Reddy S, Siraj E, et al. Giant invasive pituitary prolactinoma with falsely low serum prolactin: the significance of 'hook effect'. J Neurooncol. 2006;79:41-3 pubmed
    ..This case highlights the importance of 'Hook Effect' resulting in falsely low prolactin level, which may have significant therapeutic implication. ..
  38. Yu Y, Xu J, Fang Y, Wu X, Yang P, Jiang C, et al. Analysis of morphologic and hemodynamic parameters for unruptured posterior communicating artery aneurysms with oculomotor nerve palsy. AJNR Am J Neuroradiol. 2013;34:2187-91 pubmed publisher
  39. O Donoghue G, Kumar R, Taleb F, Marks C. Radiology quiz case 4: sphenoidal sinus mucocele. Arch Otolaryngol Head Neck Surg. 2005;131:824, 827-8 pubmed
  40. Park Y, Huh Y, Kim J. Oculomotor nerve palsy as an initial manifestation of polycythemia vera. J Clin Neurosci. 2012;19:328-30 pubmed publisher
    ..MRI also revealed an acute silent infarction in the right frontal subcortex. PV may manifest with oculomotor nerve palsy owing to a thrombotic complication and should be considered in the differential diagnosis of acute ophthalmoplegia. ..
  41. Momtchilova M, Rakotoarisoa R, Roger G, Garabedian E, Laroche L, Pelosse B. [Unilateral isolated partial third nerve palsy and sphenoiditis in a child: A case report]. J Fr Ophtalmol. 2012;35:348-52 pubmed publisher
    ..In a child with isolated unilateral mydriasis, head MRI should be performed to rule out a compressive lesion of the oculomotor nerve. ..
  42. Vighetto A, Tilikete C. [Painful oculomotor palsy: a diagnostic approach]. Rev Neurol (Paris). 2005;161:531-42 pubmed
    ..We discuss successively paralysis of the third, sixth and fourth nerve, paralysis of several ocular motor nerves, recurrent ophthalmoplegia and ischaemic ocular motor palsies, which are the most frequent cause. ..
  43. Suresh S, Abel A, Younge B, Bilyk J, Lee M. Masses in the membranes. Surv Ophthalmol. 2016;61:357-62 pubmed publisher
    ..This led to the final diagnosis of central nervous system extranodal marginal zone lymphoma. ..
  44. Hustler A, Joy H, Hodgkins P. Isolated unilateral mydriasis with delayed oculomotor nerve palsy secondary to intracranial arachnoid cyst. J AAPOS. 2009;13:308-9 pubmed publisher
    ..Isolated unilateral mydriasis may be caused by a slowly enlarging lesion, which is easily missed on neuroimaging. ..
  45. Prabhakaran V, Chohan A, Husain R, Andrew N. Third nerve paralysis as a presenting sign of essential thrombocythaemia. Eye (Lond). 2006;20:1483-4 pubmed
  46. Kuki I, Kawawaki H, Okazaki S, Ikeda H, Tomiwa K. [Successful steroid pulse therapy for acute unilateral oculomotor nerve palsy associated with norovirus infection]. No To Hattatsu. 2008;40:324-7 pubmed
    ..Idiopathic oculomotor paralysis is usually believed to be selflimited, but steroid pulse therapy should to be considered in cases ocular paralysis is so severe or progressive that immune-mediated mechanism was presumed. ..
  47. Weber E, Newman S. Aberrant regeneration of the oculomotor nerve: implications for neurosurgeons. Neurosurg Focus. 2007;23:E14 pubmed
    ..In addition, the various mechanisms that contribute to synkinesis are reviewed. Last, the treatment strategies for both oculomotor palsies and synkinesis are discussed...
  48. Tsukamoto T, Yamamoto M, Fuse T, Kimura M. [Isolated crossed superior rectus palsy in a midbrain infarction]. Rinsho Shinkeigaku. 2005;45:445-8 pubmed
    ..It is indicated that crossing fibers toward the contralateral levator muscle of the eyelid may be also involved. The patient's diplopia completely resolved two months later after the onset. ..
  49. Edgell R, Kaila J, Borhani Haghighi A. Selective endovascular aneurysm neck ligation to treat compressive cranial neuropathy. J Neuroimaging. 2013;23:211-4 pubmed publisher
    ..This technique may be considered in patients presenting with compressive cranial neuropathy and an aneurysm configuration that allows selective coiling of the inflow zone. ..
  50. el Hamdaoui M, Touitou V, LeHoang P. [Orbital cysticercosis mimicking a painful third nerve palsy]. J Fr Ophtalmol. 2012;35:818.e1-4 pubmed publisher
    ..Diplopia and local inflammation resolved after albendazole and systemic steroid treatment. Surgical resection of the cysts was unnecessary. ..
  51. Reich S. Teaching video is it III alone, or III and IV?. Neurology. 2007;68:E34 pubmed
  52. Lynch S, Lee A, Graham S, Kirby P. Primary melanoma of the sphenoid sinus presenting with a third cranial nerve palsy. J Neuroophthalmol. 2005;25:289-92 pubmed
    ..The combination of high T1 signal and low T2 signal in a mass should suggest melanin. An exceedingly rare condition, this is the first English report of its presentation with a third cranial nerve palsy. ..
  53. Ng Y, Lyons C. Oculomotor nerve palsy in childhood. Can J Ophthalmol. 2005;40:645-53 pubmed