Internuclear Ophthalmoplegia


What is Internuclear Ophthalmoplegia?

Internuclear Ophthalmoplegia is a condition which affects nerves and limits eye movement. In this condition, nerve fibers in the brainstem are damaged hence your left eye cannot look left. Your right eye manifests jerking movements when you try to look left. This is referred to as nystagmus.

Internuclear ophthalmoplegia is a type of ophthalmoplegia. Ophthalmoplegia is characterized with weakness in the eye muscles; it can affect all the muscles or only one that hold the eye in position hence affecting eye movement.

Internuclear ophthalmoplegia

Types

There are two types of internuclear ophthalmoplegia:

  • Unilateral Internuclear ophthalmoplegia
  • Bilateral Internuclear ophthalmoplegia

Symptoms

Some patients may experience diplopia on lateral gaze or complain of dizziness. Others can have double vision or blurred. Some patients may have weak muscles and numbness. Others, they find it difficult to walk around, unable to focus or fully concentrate on something.

Causes

Internuclear ophthalmoplegia is caused by the following:

Multiple sclerosis

It is a condition that affects your brain, spinal cord and optic nerves in the eyes. Multiple sclerosis occurs when a myelin (a fatty layer that protects the nerve) is damaged hence exposes your nerves to injury. Damaged myelin means that your brain cannot send messages around the body correctly as well as nerves cannot function well in assisting you to move and feel. This condition affects both children and adults. You are more likely to show the following symptoms when suffering from Multiple sclerosis:

  • Having trouble in walking
  • Blurred vision
  • Unable to focus or remember
  • Muscle weakness

Stroke

It is a medical emergence which occurs when blood flow to your brain is stopped. There are two forms of stroke you can get such as ischemic stroke which is caused when blood vessels in your brain is blocked. Hemorrhagic stroke occurs when a blood vessel breaks and bleeds in your brain. If you have stroke you exhibit the following symptoms:

  • You suddenly feel numb and weak especially in your leg, arm or face
  • Having difficulty in seeing with one eye or both.
  • Having difficulty in walking.

Bacterial infections

Lyme disease

It is a caused by bacteria and spread to people by Tick bite. When left untreated, it can affect your nervous systems leading to numbness, weakness in your facial muscle. It can lead to heart failure and swelling of the membrane surrounding your brain and spinal cord. 2

Syphilis

It is a disease caused by spirochete bacteria. You can get syphilis through the following:

  • Having sex with an infected person
  • An infected expectant mother can pass syphilis to the unborn child

This disease is manifested in different stages such as primary, secondary, latent and tertiary. You need to get treatment early to prevent syphilis from spreading in your body. In case syphilis is not treated for a long time, it damages your brain, eyes, heart nerves, bones, joints and liver.

Viral infections

Herpes simplex virus can cause serious complications such as glaucoma. Glaucoma is a situation where the optic nerve connecting your eye and the brain is injured. This happens when blood vessels in the eye is blocked. This blockage prevents fluid in your eye from draining well and piles more pressure inside your eye which in turn exerts force on optic nerves damaging them. This condition leads to Internuclear ophthalmplegia.

Glaucoma effected eye

Glaucoma effects

Diagnosis

Your doctor will conduct a physical examination on your eye to determine if you have difficulty in moving your eye. Further tests can be conducted to determine the cause of this condition such as

MRI scan

Magnetic resonance imaging (MRI) uses strong magnetic fields and radio wave to produce comprehensive images of inside of your body .It is used to scan your brain stem to identify the presence of lesions that cause internuclear ophthalmplegia.

Venereal disease research lab

This is a test carried out to determine the presence of syphilis in your body. The doctor takes a sample of your blood and analyses it to check for antigens and antibodies.

Lyme titer

When you have signs and symptoms of an infection from Borrelia, your doctor will conduct a Lyme titer test. The doctor takes a sample of your blood and analyses it to determine if you have Lyme disease.

lyme disease

Blood pressure measurement

This is test is conducted on persons with stroke. It is used to monitor post-stroke and helps your doctor to come up with ways to help a stroke patient against another brain attack.

Treatment

Internuclear ophthalmoplegia can be treated using the following:

Surgery

Surgery interventions are used to remove brainstem lesion. Surgery depends on the location of the tumor in your brain .If the tumor is in the tectum (The tectum (Latin: roof) is a region of the brain, specifically the dorsal part of the midbrain (mesencephalon)) of your midbrain; your doctor uses endoscopic third ventriculostomy (ETV) or ventricular shunt placements to treat it.

Antibiotic medication

Antibiotic medications are used to treat bacterial infection diseases like syphilis and Lyme. Syphilis is very contagious and treatment is focused on the primary and secondary stages of the disease. Your doctor will prescribe antibiotics such as Penicillin injection, Doxycycline or Tetracycline. Antibiotics help kill spirochete bacteria that cause syphilis. Penicillin injection is used when you are pregnant to protect your unborn baby as well as yourself. When you have severe symptoms of Lyme disease, your doctor will prescribe intravenous antibiotics.

Antiviral medications

These are drugs used to treat viral infections. Your doctor can prescribe the following:

  • Antiviral eye drop or ointment to prevent the virus from spreading;
  • A mixture of steroids and antiviral drops to help reduce swelling in your eye;
  • In case you experience severe symptoms of internuclear ophthalmplegia, antiviral tablets are good in effectively dealing with them.

Steroids

These drugs are used to reduce inflammations in your brain and spinal cord. Your doctor can prescribe Methylprednisolone for 3-4 days or Prednisolone for temporal inflammatory eye conditions.

Use of Blood Thinner

Blood thinners are used to treat blood vessel and heart attack diseases. Blood thinners help reduce blood clots from forming in your arteries and veins hence they can effectively minimize heart attack and stroke. There are two types of blood thinners your doctor can recommend: Anticoagulants such as Heparin and Antiplatelet drugs.

Reference List:

  1. Internuclear Ophthalmoplegia – http://healthzene.com/internuclear-ophthalmoplegia/
  2. http://www.nhs.uk/Conditions/Lyme-disease/Pages/Introduction.aspx
  3. https://medlineplus.gov/bloodthinners.html
  4. http://patient.info/medicine/prednisolone-eye-drops-for-inflammation-predsol-pred-forte-minims-prednisolone
  5. https://www.ncbi.nlm.nih.gov/books/NBK441970/
  6. https://www.uptodate.com/contents/internuclear-ophthalmoparesis
  7. https://www.youtube.com/watch?v=YBDg5VMsux4
  8. www.sciencedirect.com/topics/medicine-and-dentistry/internuclear-ophthalmoplegia

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