The eye muscle paralysis


Paralysis of the eye muscles is also known in ophthalmology as ophthalmoplegia or eye muscle paresis. This is a disease of the eyes that causes paralysis of the eye muscles. Paralysis of the eye muscles is a movement restriction of one or both eyes caused by damage to the eye muscle, the transmission point between muscle and nerve, the supplying cranial nerve or the brain.

Depending on where the damage is located, vertical, horizontal or torsional strabismus can occur. Since strabismus (strabismus inconcomittans or strabismus paralyticus) occurs from one moment to the next, double images occur. The eye muscles consist of small muscles located on the outer eye and are used to move the eyeball. In the case of ocular muscle paralysis, various causes lead to a loss of function in one or more of these muscles and, as a consequence, to a restriction of the eye’s movement.

What forms of eye muscle paralysis are there?

There are two forms:

  • Complete paralysis of the eye muscles (paralysis), very rare
  • Weakness of the eye muscles or incomplete paralysis (paresis)

The eye muscles ensure that the two eyes are coordinated in their movements and set parallel to each other. If individual or all eye muscles are paralyzed, this can no longer happen and therefore the affected persons see double vision and squint. Consequently, patients have problems grasping and coordinating, typically bumping into objects as they pass by.

Patients try to compensate for strabismus by tilting their head towards the healthy side. A blurred visual image can also be an indication of eye muscle paralysis. Other symptoms that can occur with ocular muscle paralysis depend on the cause of the disease.

Inflammation of the brain can lead to fever, headache, fatigue or nausea. The same applies to infectious diseases or poisoning. Sudden speech disorders, walking problems or hemiplegia are signs of a stroke and must be treated medically as soon as possible.

Tumours in the brain can cause paralysis of the eye muscles, fever, clouding of consciousness and changes in character. The seeing of double images is called diplopia in medical terminology and can be triggered by various diseases. In the context of an eye muscle paralysis, diplopia is caused by a shift of the visual axis.

The objects that are seen are no longer projected at the correct location on the retina. The brain cannot process the information correctly due to the faulty projection. This results in double images, which lead to blurred vision.

Headaches and dizziness can also occur. The therapy of the double images depends on the underlying disease. If double images or other signs of eye muscle paralysis are seen which have not regressed within a few hours, the affected person should immediately consult an ophthalmologist.

In case of accompanying symptoms such as paralysis or language problems that make one think of a stroke, an emergency doctor must be called immediately. The doctor first asks a few questions about the symptoms and accompanying symptoms, which enables him to take a detailed medical history of the patient. This is followed by an eye examination.

A further step is an electromyography (EMG) of the eye muscles, with which paralysis can be detected. In some cases, it may be necessary to perform brain imaging using MRI. Additional blood tests provide information about possible inflammatory processes or the presence of an infection.

In any case, a detailed neurological examination, an ENT examination and a radiological clarification must be carried out before a therapy is initiated. In the therapy of ocular muscle paralysis, the treatment of the underlying disease is in the foreground and is therefore individually different in each case. Since eye muscle paralysis can heal spontaneously, surgery is normally not attempted until about one year after the onset of paralysis.

Before this time, an attempt is made to find the causes of the paralysis. Above all, it is important to exclude a brain disease so that a targeted therapy can then be started. Depending on the cause, anti-inflammatory medication is given, tumours are removed if possible, muscles may have to be shortened to compensate for strabismus.

A frosted glass can also be worn in front of the eye to minimize the disturbing double images or prisms can be used to compensate. The acute symptoms caused by paralysis of the eye muscles can be treated by an ophthalmologist. The patient must wear so-called prism glasses to counteract the double images.

These are glasses that are covered with a special prism foil. This compensates the double images and the patient can see clearly again. It is also possible to mask one eye so that the double images disappear.

If the eye muscle paralysis is caused by an inflammation in the brain (e.g. MS), treatment is by administration of cortisone. Bacterial infections of the head area can usually be treated well with antibiotic drugs. Surgical treatment may be necessary for brain tumours that press on nerves or severe injuries to the head.

In any case, paralysis of the eye muscles must be clarified by an ophthalmologist and possibly also neurologically or internally, in order to quickly find the cause and be able to initiate appropriate treatment. In principle, the eye muscles are built like any other muscle in the body and can therefore be trained in a targeted manner. In the case of visual disorders that are due to eye muscle weakness or paralysis (for example strabismus or double vision), training helps to improve the symptoms.

This involves fixing an object, e.g. a ballpoint pen or eraser, in front of the face at eye level with one eye and moving it slowly in different directions. The other eye is covered. The distance between the object and the face should be about 30-40 cm.

The aim of the training is to follow the object with the eyes and not to move the head. The head should not be moved as this would relieve the eye muscles and the training effect would be lost. Eye muscle paralysis can be the result of numerous disorders and diseases.

If the cranial nerves that supply the muscles are damaged, the result is paralysis of the respective muscle. The damage can be caused by an injury to the head, inflammation of the brain or cerebral circulatory disorders (stroke). Another cause of eye muscle paralysis is diseases of the eye muscles themselves, such as inflammation of the muscles.

Eye muscle inflammation often occurs as part of hyperthyroidism: patients then suffer from severely swollen eye muscles that cannot be moved and the eyes swell up (exopthalmus). Eye muscle paralysis can also occur as a result of bleeding in the brain, poisoning, tumour diseases or infectious diseases. Of course, injuries directly to the eye can also lead to eye muscle paralysis and disturbances in eye movements.

Temporary paralysis of the eye muscles can also be an alarm signal, as it can herald a stroke. And, as a result,

  • Damage to one or more nerves belonging to the eye muscle (3rd, 4th or 6th cranial nerve)
  • A signal transduction disorder from nerve to muscle,
  • A muscle disease

One cause for the appearance of an eye muscle paralysis can be stress. Tiredness or persistent internal tension also promotes the development of eye muscle paresis.

Constant stress can lead to overexertion of the eye muscles. The muscles can no longer work synchronously and the complex interaction of the eyeballs during the visual process fails. The affected persons start to squint and see double images.

This is a harmless trigger and with appropriate countermeasures, improvement occurs quickly. Nevertheless, paralysis of the eye muscles as a result of excessive stress is a clear warning sign of the body and should definitely be taken seriously by those affected. Measures that serve to reduce stress and relax include autogenic training and progressive muscle relaxation.

Both techniques can easily be carried out at home using video instructions and have proven to be effective in stress management. But also simple habits, such as regular sport, mindfulness in everyday life, enough punch and a varied, healthy diet contribute to mental well-being and reduce stress. This could also be interesting for you: How can stress be reduced?

The duration of an eye muscle paralysis depends on the cause. The symptoms do not necessarily have to last forever. In some cases the disease can heal spontaneously after a few weeks or months, for example after a circulatory disorder in the brain.

Eye muscle paralysis can also become chronic. Whether an ocular muscle paralysis is curable depends on the triggering basic disease. If it can be treated well, the paralysis of the eye muscle usually disappears.

Especially if the paralysis is caused by psychological stress, there are good chances of recovery with appropriate treatment. The appearance of an ocular muscle paralysis can be caused by a stroke (apoplexy). As a result of a circulatory disorder in the brain, there is an undersupply of certain areas and symptoms of failure.

Classical symptoms of a stroke are sudden speech disorders, hemiplegia and dizziness. If the circulatory disorder affects areas that are responsible for supplying the eye muscles, paralysis of the eye muscles and double vision occur. Strokes are more likely to affect older people and the failure symptoms are often concentrated in one eye.

A stroke is an absolute emergency where every minute counts. If a stroke is suspected, those affected need immediate medical help, otherwise there may be severe damage to the brain. In young people in particular, paralysis of the eye muscles can also be caused by a more serious disease such as multiple sclerosis (MS).

Multiple sclerosis is an autoimmune disease that causes inflammation of the central nervous system (i.e. the brain and spinal cord). The disease often manifests itself at the beginning in the form of visual problems such as visual field failures or paralysis of the eye muscles. In MS, an incorrect programming of the immune system leads to destruction of the medullary sheaths around nerve cells, focal points of inflammation form and the function of the nerve tissue is restricted.

If the inflammation affects the nerves that supply the eye muscles, eye muscle paralysis occurs. Typically, both eyes are affected by the failure symptoms. – Optic nerve inflammation in MS

  • Course of multiple sclerosis

Paralysis of the eye muscles can occur as a concomitant symptom of neuroborreliosis.

This leads to an infection of the central nervous system with borrelia. Borrelia are bacteria that are usually transmitted by a tick bite. The pathogens multiply and lead to complaints of the nervous system after a few weeks.

Pain, meningitis or facial paralysis can occur. Due to a dysfunction of the cranial nerves, the eye muscles are also often affected by the paralysis symptoms. Accompanying symptoms are also neck stiffness and fever.

A neuroborreliosis should be treated immediately with appropriate medication, as otherwise a progressive deterioration of the state of health can occur. You can also find out more under: Lyme disease – You should know that!