OPHTHALMOPLEGIA (ophthalmoplegia; Greek ophthalmos of eyes + plege blow) — paralysis of several or all eye muscles innervated oculomotor, block and taking away nerves. At paralysis of outside muscles of an eye there is outside O., at paralysis of internal (intraocular) muscles — internal the Lake. If extent of paralytic weakening of each muscle is not identical, then partial outside O. develops or partial internal O. Paralich of outside and internal muscles of an eye takes also full outside O. to full O. Razlichayut and full internal O. Oftalmoplegiya of any kind can be one - and bilateral.
At unilateral full outside O. the immovability of an eyeglobe develops and ptosis (see). At bilateral full outside O. there is an immovability of eyeglobes, a ptosis. When there is no ptosis, a peculiar look — Getchinson's face is noted (see. chronic progressing ). Such patient, to see objects, shall turn to them the head or all case. At partial outside O. the eyeglobe deviates towards action of the healthy or less paralyzed muscle; in the direction of actions of the affected muscles of its movement are limited or at all are absent and doubling of objects appears.
At full internal O. it is noted a mydriasis, lack of its photoharmose and convergence, paralysis of accommodation (see. Accommodation of an eye , Convergence of eyes ); at partial internal O. most often — only a mydriasis with lack of a photoharmose at safety of the act of convergence and accommodation.
At full O. the ptosis, an immovability of an eyeglobe, an absolute immovability of a pupil and small is observed exophthalmos (see).
Lakes are subdivided on inborn and acquired. At topical diagnosis nuclear, radicular and trunk distinguish O. (defeat of nervous trunks on the basis of a brain, in a cavernous sine, in the field of an upper orbital crack).
Inborn nuclear O. are result of an aplasia of kernels of third cranial nerves that sometimes is followed by lack of nervous trunks and changes of eye muscles. They can be combined with malformations of an eyeglobe and other bodies and be observed at several family members.
The acquired nuclear O. usually happen bilateral and arise owing to defeat of kernels of the oculomotor and block nerves located in gray matter of a bottom of a water supply system of a brain (a silviyev of a water supply system). The reason of the acquired nuclear O. (acute and chronic) are encephalitis of various etiology, Demyelinating diseases, syphilis, tuberculosis, intoxications (at diphtheria, tetanus, botulism), a hypovitaminosis of Vkh, B2, C, lead poisoning, carbon monoxide, alcohol, barbiturates, defeats of vessels of a mesencephalon (a hemorrhage, thrombosis, aneurisms), new growths of a mesencephalon, a pinus and back departments of the third cerebral cavity, a craniocereberal injury.
Bilateral nuclear O. are characterized by various extent of damage of separate oculomotor muscles, a bilateral ptosis or a semi-ptosis. Defeat of kernels of nerves of lateral muscles of an eye, as a rule, develops against the background of lack of reaction of pupils to light, paralysis of convergence and accommodation is noted.
At defeat of the pair additional kernel (a small-celled kernel of Yakubovich — Edingera — Vestfalya) sending parasympathetic fibers to a sphincter of an iris and a ciliary muscle, and the central back kernel (a kernel of Perlia) connected with convergence there is bilateral internal a Lake.
At defeat of the nadjyaderny parasympathetic educations narrowing a pupil, located in pretektalny area between posterosuperior departments of thalamuses (visual hillocks) and to lobbies chetverokholmiy the Lake develops partial internal. This pathology is more often shown by bilateral lack of a pupillary test on light at safety of convergence and accommodation (reflex immovability of pupils). If patol, process strikes the carrying-out systems a chetverokholmiya knowing the act of convergence and the central back kernel, then, in addition to lack of reaction of pupils to light, there are disturbances of convergence.
At defeat of third cranial nerves on the basis of a brain there is her unilateral O. Prichinami tumors of basal localization, pia-arachnites, subarachnoidal hemorrhages, aneurisms, a craniocereberal injury with a fracture of base of the skull are.
At a syndrome of a cavernous sine the unilateral O. full or partial, is combined with defeat of the first branch of a trifacial, disturbance of venous outflow from an eye-socket and an exophthalmos. The arterial intrakavernozny aneurisms, adenomas of a hypophysis and basal meningiomas growing into a cavernous sine, a traumatic arteriokavernozny anastomosis are the reason of development of this syndrome. At a syndrome of an upper orbital crack full or partial O., defeat of the first branch of a trifacial, the expressed exophthalmos and disturbance of venous outflow from an eye-socket are noted. If the top of an eye-socket is involved in process, then symptoms of damage of an optic nerve join (a congestive nipple, an atrophy of a disk primary or secondary, neuritis), visual function is quickly broken. The syndrome of an upper orbital crack arises at the tumors, inflammatory and vascular processes extending kranioorbitalno.
Bilateral O. owing to defeat of third cranial nerves on the basis of a brain meets seldom, it usually malignant tumors of basal localization are the reason.
Ophthalmoplegic migraine — the rare disease which is shown attacks of headaches in combination with unilateral full or partial of migraine ophthalmic migraines can precede O. Pristup. Duration of headaches — from several hours to several days, O. disappears later, function of third cranial nerves is recovered gradually.
Treatment of different types of O. consists in treatment of a basic disease.
Bibliography: Questions of neuroophthalmology, under the editorship of I. I. Merkulov, t. 5, page 5, Kharkiv, 1960, t. 7, page 5, 1966; About l about in and S. S N. Clinical ophthalmology, t. 1, the p. 3, page 798, M. — Pg., 1923; Sokolova of O. N. Oftalmonevrologiya of defeats of a mesencephalon, M., 1971, bibliogr.; Shakhnovich A. R. and Shakhnovich of V. R. Pu-pillografiya, M., 1964; Cog an D. G. Neurology of the ocular muscles, Springfield, 1956; Glaser J. S. Neuro-ophthalmology, Hagerstown a. o., 1978; Neuro-ophthalmologie, hrsg. v. R. Sachsenweger, Lpz., 1975; W a 1 s h F. B. a. H o y t W. F. Clinical Neuro-ophthalmology, Baltimore, 1969; Weinstein P. Ophthalmolo-gische Differentialdiagnose bei Gehirntu-moren, Budapest, 1972.
O. H. Sokolova.