Etiology, Clinical Symptoms, and Risk Factors of Oculomotor Nerve Paralysis
Abstract
The third cranial nerve, also known as the oculomotor nerve, consists of two main components: the external parasympathetic fibers that innervate the ciliary muscles and the sphincter pupillae, and the deep somatic fibers that control the levator palpebrae superioris and four extraocular muscles. Oculomotor nerve palsy has multiple etiologies and can indicate severe underlying pathology. Damage to this nerve results in characteristic symptoms such as ptosis, diplopia, restricted eye movement, and diminished or absent pupillary light reflex. This study aims to evaluate the clinical characteristics of oculomotor nerve paralysis based on its etiology, age distribution, gender prevalence, and associated risk factors. This study employs a literature review using a narrative review design. Data were collected from various indexed and accredited electronic sources such as Scopus, SINTA, DOAJ, SpringerLink, Cochrane, Biomed, Portal Garuda, Google Scholar, Elsevier/Clinical Key, Gale, PubMed, and other relevant databases. A total of 13 relevant articles were identified for this narrative review. The findings indicate that vascular abnormalities, including microvascular ischemia, aneurysms, and subarachnoid hemorrhages, are the most frequent causes of oculomotor nerve paralysis. The most commonly reported symptoms among affected patients are ptosis and diplopia. The condition is most prevalent in individuals aged 51-60 years, and women are more susceptible to oculomotor nerve paralysis than men. The most frequent cause of oculomotor nerve paralysis is an aneurysm of the posterior communicating artery. This condition predominantly affects individuals aged 51-60 years and is more common in women.
References
Abdurahman, E., Amod, K., Royston, D., & Harrichandparsad, R. (2020). Recovery of Oculomotor Nerve Palsy after Endovascular Management of Posterior Communicating Artery Aneurysms. South African Journal of Radiology, 24(1). https://doi.org/10.4102/sajr.v24i1.1887
Bhandari, S., & Yadalla, D. (2013). Incidence of Pupillary Involvement, Course of Anisocoria and Ophthalmoplegia in Diabetic Oculomotor Nerve Palsy. Indian Journal of Ophthalmology, 61(9), 533–534. https://doi.org/10.4103/0301-4738.119462
Boutari, C., & Mantzoros, C. S. (2022). A 2022 update on the epidemiology of obesity and a call to action: as its twin COVID-19 pandemic appears to be receding, the obesity and dysmetabolism pandemic continues to rage on. Metabolism, 133, 155217. https://doi.org/10.1016/j.metabol.2022.155217
Calcei, J. B., Powers, M. P., Clark, S., & Gusz, J. R. (2022). Initial Management of the Trauma Patient. In Peterson’s Principles of Oral and Maxillofacial Surgery (pp. 473-513). Cham: Springer International Publishing. https://doi.org/10.1016/j.cxom.2012.12.005
Canzi, G., Novelli, G., Mirabella, S., & Sozzi, D. J. A. E. N. S. S. S. K. G. P. S. C. S. (2023). The comprehensive facial injury (cfi): a modern communication tool on maxillo-facial traumas characteristics. ARCHEIA ELLĪNIKĪS STOMATIKĪS KAI GNATHOPROSŌPIKĪS CHEIROURGIKĪS, 2(24), 113-113. http://dx.doi.org/10.54936/haoms242p74
Chen, H., Wang, X., Yao, S., Raza, H. K., Jing, J., Cui, G., & Hua, F. (2019). The Aetiologies of Unilateral Oculomotor Nerve Palsy: A Clinical Analysis on 121 Patients. Somatosensory & Motor Research, 36(2), 102–108. https://doi.org/10.1080/08990220.2019.1609438
Creswell, J. W. (2019). Research design pendekatan kualitatif, kuantitatif, dan mixed (A. Fawaid & S. Z. Qudsy, Eds.; 5th ed., Vol. 3). Yayasan Mitra Netra.
Dhany, R. K., Tanjung, Y., & Jennel, F. (2019). Insiden dan Etiologi Kelumpuhan Saraf III, IV dan VI yang Disertai Diplopia Binokuler di RSUD DR. Wahidin Sudirohusodo. Jurnal Ilmiah Kedokteran Wijaya Kusuma, 8(2), 1–6. https://doi.org/10.30742/jikw.v8i2.480
Dinaki, K., Sarafidou, A., Papadopoulos, C., Triaridis, S., & Karkos, P. (2023). Intra-cavernous aneurysm: a rare complication mimicking Tolosa Hunt syndrome. Authorea Preprints. https://doi.org/10.22541/au.170065843.32138098/v1
Fang, C., Leavitt, J. A., Hodge, D. O., Holmes, J. M., Mohney, B. G., & Chen, J. J. (2017). Incidence and Etiologies of Acquired Third Nerve Palsy Using a Population-Based Method. JAMA Ophthalmology, 135(1), 23. https://doi.org/10.1001/jamaophthalmol.2016.4456
Forrester, J. V., Dick, A. D., McMenamin, P. G., Roberts, F., & Pearlman, E. (2015). The eye: basic sciences in practice. Elsevier Health Sciences.
Habeel, S., Kumar, K., MacIntosh, P. W., & Shah, V. M. (2022). The Incidence and Etiology of 3rd, 4th, 6th, and Multiple Cranial Nerve Palsies in South India: A 6-Month Retrospective Prevalence Study. Journal of Ophthalmology & Clinical Research, 6(2), 133–138. https://dx.doi.org/10.33140/JOCR
Halvorson, K. L. (2018). Cranial Nerve III Palsy. Clinical Cases in Eye Care. Wolters Kluwer Health.
İlksen Çolpak, A., & Batur Çağlayan, H. (2019). Isolated Third, Fourth, and Sixth Cranial Nerve Palsies in the Turkish Population: Etiologic Factors and Clinical Course. Turkish Journal Of Neurology, 25(1), 32–35. https://doi.org/10.4274/tnd.galenos.2019.29795
Joyce, C., Le, P. H., & Peterson, D. C. (2023). Neuroanatomy, Cranial Nerve 3 (Oculomotor). StatPearls Publishing.
Kanazawa, T., Hino, U., Kuramae, T., & Ishihara, M. (2020). Idiopathic Unilateral Oculomotor Nerve Palsy: A Case Report. Heliyon, 6(12), e05651. https://doi.org/10.1016/j.heliyon.2020.e05651
Kmeid, M., & Medrea, I. (2023). Review of Tolosa-Hunt syndrome, recent updates. Current Pain and Headache Reports, 27(12), 843-849. https://doi.org/10.1007/s11916-023-01193-4
Kondziella, D., & Waldemar, G. (2023). Clinical history and neuroanatomy:“where is the lesion?”. Neurology at the Bedside, 5-83. http://dx.doi.org/10.1007/978-3-031-43335-1_2
Kumar, K. H., Bhanu, K. B. C., & Ashok, R. (2018). Clinical Study of 3rd, 4th and 6th Cranialnerve Palsies Leading to Visual Disturbances. International Journal of Contemporary Medical Research [IJCMR], 5(4). https://doi.org/10.21276/ijcmr.2018.5.4.48
Kumar, M. P., Vivekanand, U., & Umakanth, S. (2014). A Study of Etiology And Prognosis of Oculomotor Nerve Paralysis. Edorium J Neurol, 1, 1–8. http://dx.doi.org/10.5348/n06-2014-1-OA-1
Kusumastuti, A., & Khoiron, A. M. (2019). Metodologi Penelitian Kualitatif (F. Annisya & Sukarno, Eds.). Lembaga Pendidikan Sukarno Pressindo.
Mak, S., Qiu, L., & Ng, Y. (2018). Recovery of Oculomotor Nerve Palsy after Endovascular and Surgical Treatment of Posterior Communicating Artery Aneurysms: A Single Institutional Experience. Asian Journal of Neurosurgery, 13(03), 555–559. https://doi.org/10.4103/1793-5482.238085
Moleong, L. J. (2021). Metodologi Penelitian Kualitatif (40th ed., Vol. 14). Remaja Rosdakarya.
Mukherjee, S., Ali, S., Hashmi, S., & Jahan, S. (2023). History, origin and types of neurological disorders. In Applications of stem cells and derived exosomes in neurodegenerative disorders (pp. 1-32). Singapore: Springer Nature Singapore. https://doi.org/10.1007/978-981-99-3848-3_1
Nagendran, S. T., Lee, V., & Perry, M. (2019). Traumatic Orbital Third Nerve Palsy. British Journal of Oral and Maxillofacial Surgery, 57(6), 578–581. https://doi.org/10.1016/j.bjoms.2019.01.029
Natarajan, D., Kannam, M., Reddy, M. V. V., & Sachdeva, V. (2022). Systemic Lupus Erythematosus and Third Nerve Palsy: Unusual Presentation and Review of the Literature. Neuro-Ophthalmology, 46(2), 109–114. https://doi.org/10.1080/01658107.2021.1912113
Nurul-Ain, M., Wan Hitam, W. H., Shatriah, I., & Abdul Halim, S. (2022). Isolated Third Cranial Nerve Palsy: Aetiology - Clinical Profile and Recovery at a Tertiary Neuro-ophthalmology Centre on the East Coast Peninsular of Malaysia. Journal of Health Science and Medical Research, 41(2), 1–13. https://doi.org/10.31584/jhsmr.2022901
Pacinella, G., Ciaccio, A. M., & Tuttolomondo, A. (2022). Endothelial dysfunction and chronic inflammation: the cornerstones of vascular alterations in age-related diseases. International Journal of Molecular Sciences, 23(24), 15722. https://doi.org/10.3390/ijms232415722
Rotariu, D., Babes, E. E., Tit, D. M., Moisi, M., Bustea, C., Stoicescu, M., ... & Bungau, S. G. (2022). Oxidative stress–Complex pathological issues concerning the hallmark of cardiovascular and metabolic disorders. Biomedicine & Pharmacotherapy, 152, 113238. https://doi.org/10.1016/j.biopha.2022.113238
Rozema, R., Doff, M. H., Delli, K., Spijkervet, F. K., & van Minnen, B. (2022). Diagnostic accuracy of physical examination findings for midfacial fractures: a systematic review and meta-analysis. Clinical Oral Investigations, 26(4), 3405-3427. https://doi.org/10.1007/s00784-022-04423-y
Rudolph, J., & Katz, J. M. (2016). Cerebrovascular complications of malignancy. In Neurological Complications of Systemic Cancer and Antineoplastic Therapy (pp. 123-133). CRC Press.
Saad, G., Ben Abdelkrim, A., Beizig Maaroufi, A., Njah Kacem, M., Chaieb Chadli, M., & Ach, K. (2020). Clinical Patterns of Third Nerve Palsies in Diabetic Patients. La Tunisie Medicale, 98(6), 513–517.
Tian, L., & Fu, Q. (2020). Recovery of Posterior Communicating Artery Aneurysm Induced Oculomotor Nerve Palsy: A Comparison between Surgical Clipping and Endovascular Embolization. BMC Neurology, 20(1), 351. https://doi.org/10.1186/s12883-020-01847-5
Tousignant, B. (2017). Optometric Management of a Third Nerve Palsy in a Prison Setting. Canadian Journal of Optometry, 79(3), 9-15. http://dx.doi.org/10.15353/cjo.79.296
Vaphiades, M. S., & Roberson, G. H. (2017). Imaging of Oculomotor (Third) Cranial Nerve Palsy. Neurologic Clinics, 35(1), 101–113. https://doi.org/10.1016/j.ncl.2016.08.009
Varallo, F. R., Dagli-Hernandez, C., Pagotto, C., de Nadai, T. R., Herdeiro, M. T., & de Carvalho Mastroianni, P. (2017). Confounding variables and the performance of triggers in detecting unreported adverse drug reactions. Clinical Therapeutics, 39(4), 686-696. https://doi.org/10.1016/j.clinthera.2016.11.005
Wang, R., Gao, Y., Wu, S., Cai, X., Yu, T., & Wang, L. (2023). Research Hotspots and Trends of Oculomotor Nerve Palsy from 2001 to 2021 Based on Web of Science: A Bibliometric Analysis. Frontiers in Neurology, 14. https://doi.org/10.3389/fneur.2023.1112070
Witthayaweerasak, J., Tansuebchueasai, N., & Aui-aree, N. (2020). Clinical Prediction Score for Early Neuroimaging in Acquired Isolated Oculomotor Nerve Palsy. Eye and Brain, Volume 12, 89–95. https://doi.org/10.2147/EB.S253305
Yi, T. M. (2020). Cranial Nerves. Anatomy, Function and Clinical Significance (1st ed.). Nova Sscience Publishers.
Zeynal, M., & Şahin, M. H. (2023). Predictive Role of Posterior Communicating Artery Spasm on Axonal Degeneration in Oculomotor Nerve Root Following Subarachnoid Hemorrhage: Experimental Study. New Trends in Medicine Sciences, 4(2), 73-82. https://doi.org/10.56766/ntms.1277530
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