Clinical Profile of Ocular Motor Nerve Palsies at Tertiary Eye Care Centre in South India

Introduction: The diagnosis and management of ocular motor nerve dysfunction varies according to the age of the patient, characteristics of the ocular motor nerve palsies, and presence of associated symptoms and signs. Purpose of the Study: To analyse the various etiology, clinical presentations, recovery pattern in patients with third, fourth, and six cranial nerve palsies in Indian population. Methods: This is a prospective study of patients diagnosed with ocular motor nerve palsies presented at tertiary eye centre within period of 2012 2015. Results: We identified 150 patients diagnosed with involvement of third, fourth, sixth and multiple cranial nerve palsies. Mean age of onset was 54.7 years (23 81 years), with female preponderance 51.3% (77 females). Majority of our patients presented with double vision in 87 (58%) cases, followed by ptosis in 27 (18%) cases; headache and pain in eyes in 19 (12.7%) cases and 11 (7.3%) cases respectively. The most common cranial nerve palsy was the sixth cranial nerve with 58 cases (38.7%). Of 150 cases, the causes were ischemia 67 (44.7%), trauma 37 cases (20.7%), idiopathic 18 (12%). Pupil was spared in 26 cases (78.8%) in ischemic palsies, while pupil was involved in 3 cases (66%) in neoplasms. We found no case of aneurysms causing third nerve palsy. Cranial nerve palsy patients from ischemic cause spontaneously improved 49 of 67 cases (73%) in 6 months. Conclusions: Sixth cranial nerve palsy was the most common cranial nerve palsy. Most common etiology was ischemia. Majority of patients with cranial nerve palsy from ischemic cause spontaneously improved in 6 months. Neuroimaging plays important role to evaluate, diagnose and treat acute ocular motor palsies.