A painful ophthalmoplegia is an oculomotor palsy that is accompanied by orbital, facial, and cranial pain.
Etiologies of a painful ophthalmoplegia are very numerous (ischemic, vascular, compressive, or inflammatory). Indeed, almost all ophthalmoplegia (กล้ามเนื้อตาอ่อนแรง which is the term in Thai) can be accompanied by pain.
How To Deal With Painful Ophthalmoplegia
- Consider the age of the subject (child, young, or old adult)
- The interview must specify the characteristics of the pain (seat and time of onset) and the patient’s general or traumatic history
- Pain preceding ophthalmoplegia leads to temporal arteritis (in the elderly), ophthalmoplegic migraine (in children), diabetic ophthalmoplegia, or carcinomatous meningitis
- Predominant ear pain is suggestive of nasopharyngeal carcinoma or Gradenigo’s syndrome
- Any neighborhood infection should be noted as well as the notion of even old trauma.
- A careful clinical examination should determine the affected oculomotor nerve (s) and the condition of the fundus and pupil. Chemosis and vascular dilation are sought at the conjunctiva
- The complementary explorations are discussed according to each clinical case. These explorations are to be envisaged according to the geographical place and the performance of the carried out explorations. A scanner in urgency can thus be interesting. It can reveal a tumor of the cavernous sinus or hemorrhage, and some recent scanner techniques can allow visualization of the vessels
An ophthalmoplegic migraine will be mainly evoked in a child under 10 years old with a family history of migraines and a personal history of headache. The orbital and periorbital pain is followed by paralysis of the III, which regresses in a few days or weeks.
In children under 10, neuroradiological exploration is not systematic. On the other hand, from the age of 20, one must always try to eliminate an aneurysm and know how to push further investigations.