Is Eye Movement A Risk Factor In A Cranial Nerve Palsy Patient?

Posted on Sun, 14 Feb 2016

Medically reviewed by Ask A Doctor - 24x7 Medical Review Team

Sun, 14 Feb 2016 Answered on

Thu, 21 Apr 2016 Last reviewed on

Question : Hi XXXXXXX
suffer from diplopia
If I have A 3 4 OR 6 Cranial Nerve Palsy or muscle paralysis/ weakness ? Would the eye still move through its normal eye movements?

Answered by Dr. Neeraj Kumar (21 minutes later)

Brief Answer:
The movement will depend upon etiology

Detailed Answer:
Hello,
I have gone through your question and understand your concerns.
Diplopia occurring due to nerve palsy will lead to deviated eyes and complete movement of eyes in all directions will not occur. Most restrictions will occur in the direction of action of nerve.
In cases with ocular globe involvement the deviation is relatively fixed with inability to move eyes actively or passively.
In some cases like myasthenia the symptoms and sign are fluctuating.
Hope you found the answer helpful.
Do get back to me for further queries.
Regards
Dr N Kumar
Neurologist

Above answer was peer-reviewed by : Dr. Vaishalee Punj

Follow up: Dr. Neeraj Kumar (1 hour later)

OK, EYES MOVE IN ALL DIRECTIONS WITH NO FACIAL PARALYSIS
BUT STILL HAVE DIPLOPIA WITH RAPID ONSET IN THE MAJORITY

If one has a high blood sugar level
can it cause diplopia without causing blurring of vision first or at all

Answered by Dr. Neeraj Kumar (2 hours later)

Brief Answer:
Diabetes may cause cranial neuropathy

Detailed Answer:
Hello,
The manifestation of diplopia and movement abnormalities depends upon etiology.
In diabetes, cranial neuropathy are common leading to diplopia.
It will be easy if you put the actual condition.
Regards
Dr N Kumar
Neurologist

Above answer was peer-reviewed by : Dr. Naveen Kumar

Follow up: Dr. Neeraj Kumar (23 minutes later)

Answered by Dr. Neeraj Kumar (10 hours later)

Brief Answer:
Provide full clinical details

Detailed Answer:
Hello,

Diplopia with normal eye movements can occur mostly in 6th nerve involvement with diplopia occurring in extreme lateral gaze. However diplopia may be present with actual visible eye deviation.
Diplopia charting is done to ascertain the type of diplopia or squint.
In diabetes diplopia occurs due to involvement of cranial nerve.

Provide full patient details which will allow me to have an useful discussion.

Regards
Dr N Kumar
Neurologist

Above answer was peer-reviewed by : Dr. Prasad

Follow up: Dr. Neeraj Kumar (7 hours later)

AGE 59 MALE
2006
ONE PUNCH LA FORTE 2 FRACTURE 2006
PLATE INSERTED UNDER LEFT EYE BALL IN 2006 TO STABALIZE FRACTURE
THE PLATE UNDER LEFT EYE WAS SPLINTERED WITH PIECES GOING INTO LEFT SINUSES HAD PIPLOPIA AT THE TIME
2006 MVA
2008 3 MVAS WHIPLASHES
2012 SLIP FALL HURT RT ANKLE TORE STRAINED SPRAIN LIGS SORE BACK
2012 GOT A HIT IN FACE BY ACCIDENT TWISTED LEFT EYE PLATE DEVELOPED LATERAL DIPLOPIA HAD IT EVER SINCE
REMOVED LEFT EYE PLATE
2014 MVA WHIPLASH
2015 EARLY HAD A ASSAULT HURT BACK NECK AGAIN 2 DISC PROLAPSES C56-AND C67
2015 AUGUST MVA MY CAR STATIONARY LOW SPEED BUT GOOD GOLT SAUSED LOTS OF HEADACHES
LATE 2015 STARTED TAKING ANTI DEPRESSANTS APO ESCITOPHAM 10 MG
TOLD DOCTOR OCT 2015 NOTICED CHANGE BLURRING OF VISION MEDIUM DISTANCE AT FOOT OR AT CEILING DISTANCE SHORTLY AFTER HAD FALL DOWN STEPS DUE TO BLURRING ,COULD NOT MAKE STEPS OUT AND UN STABLE RIGHT ANKLE BAD FALL 2 LUMBAR DISC INJURIES AND BAD LEFT ANKLE GRADE 2 STRAINS
STARTED TAKING LYRICA DUE TO BACK LEG PAIN
APPROX 2.5 MONTHS LATER GOT DOUBLE CENTRAL VISION
AGGRIVATED BY RIGHT LATERAL HEAD TILT AND ROTATION OF HEAD INC EXTENSION OF HEAD
DOUBLE FROM APPROX MID LINE AND DOWN WORSE LOOKING AT FEET. THINGS GET FURTHER APART
DIPLOPIA IS ABOVE AND BELOW VERTICAL?
STEPS ARE DOUBLE AND TWISTED AT A ANGLE
ONE EYE CLOSED REDUCES DIPLOPIA BILATERALLY
BLOOD TEST INC THYRIID OK GLUCOSE 20 JUST HAD A WATER MELON BEFORE TESTING AT HOSPITAL
NORMALLY 10 -12
EYE CLINIC SAID NERVE PALSY?
WENT TO PRIVATE NEUROLOGIST SAID CAUSE NOT NEUROLOGIC OR DIABETES RELATED
HOPE THIS HELPS

Follow up: Dr. Neeraj Kumar (1 minute later)

PLEASE NOTE ALL MVAS NOT MY FAULT
ALL 3 PARTY

ALSO HAVE GOOD VISION NOT BLURRING ,AT A DISTANCE BETTER THAN 20/20 . JUST CLOSE UPS
PUPILS SAME SIZE
ALL MOVEMENTS OF EYES POSSIBLE IN ALL DIRECTIONS
NO EYE LID DROPPING
CT AND MRI CLEAR
NO OBSTRUCTION TO TROCHLEAR NERVES ALL GOOD SO RADIOLOGIST SAY?FIELD OF VIEW TESTS SAY NO PRESSURE FROM TUMOE BLOOD VESSEL ETC

RECENTLY HAD SINUS INFECTION TOOK ANTIBIOTICS

BLOOD AND EYE PRESSURE GOOD

Answered by Dr. Neeraj Kumar (1 hour later)

Brief Answer:
Possibility of ocular cause of diplopia

Detailed Answer:
Hello,
Reviewed your history.
According to me the reason for your diplopia especially vertical is ocular due to fracture orbital wall and disturbed dynamics of eye movements.
The Mri brain is normal so possibility of any nerve involvement in the path to eyes is unlikely.
Go to an Ophthalmologist with expertise in squint surgery for evaluation regarding diplopia.
Hope you found the answer helpful.
I can understand your agony and am with you for all your queries.
Regards
Dr N Kumar
Neurologist

Above answer was peer-reviewed by : Dr. Yogesh D