Shakila, A (2020) A Clinical Study on Ocular Motor Nerve Palsies following Trauma. Masters thesis, Madras Medical College, Chennai.
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Abstract
INTRODUCTION: The term “Ocular motor system” refers to the entire somatic motor system which controls the position and movements of the eyes. It includes extraocular muscles, the cranial nerves and their nuclei that innervate them and the forces that stimulate and inhibit their actions. “Ocular motor nerves” refers to third (Oculomotor), fourth (Trochlear) and sixth (Abducent) cranial nerves. Superior rectus, medial rectus, inferior rectus, inferior oblique, levator palpebrae superioris and the intrinsic muscles of the eye are supplied by the Oculomotor nerve. Superior oblique is supplied by the Trochlear nerve. Lateral rectus is supplied by the Abducent nerve1. Ocular motor nerves control the extra ocular movements of the eyes. Restricted ocular mobility can occur as the result of paralysis of the nerves supplying the extra ocular muscles or due to the pathology in the muscle itself or there may be the pathology at the myoneural junction. AIM OF THE STUDY: The aim of the study is to study the clinical profile of ocular motor nerve palsies following trauma, the mode of injury, the most commonly involved nerve palsy following trauma and to assess the recovery of post traumatic nerve palsy. MATERIALS AND METHODS: The cases studied included those patients with neurogenic motor nerve palsies who presented to RIOGOH, Egmore, Chennai for a period of One year, March 2018 - February 2019. They were registered, evaluated and followed up during the study period. RESULTS: Out of the 40 cases studied, the age group ranged from 17-68 years, 52.5% of cases were in the age group of 31-50 years .The mean age of presentation of third,fourth and sixth nerve was 47.0,38.0 and 37.92 respectively. Third nerve palsies occurred in a wide range of age group.There was a preponderance in males (62.5%) than in females(37.5%) in all ocular motor nerve palsies. In the study RTA was most common cause of ocular motor nerve palsy in 40% of the patients. Ocular trauma caused about 15% cases of ocular motor nerve palsy. The most common nerve involved in trauma is the oculomotor nerve(40%), followed by VI nerve(32.5%), III, IV, VI nerves(15%), IV nerve(7.5%) respectively.In 55% of patients neuroimaging was normal. Traumatic nerve palsies had full recovery in 57.5% of patients. Partial recovery in 25% of patients. 12.5% were not recovered at the end of the study. In this study, 43.75% of patients with third nerve palsy had full recovery, whereas 31.25% of patients had partial recovery and 12.5% of patients did not recover. 2 patients had aberrant regeneration. CONCLUSION: Cranial nerves can be injured before, during or after their passage through the skull. Closed head injury even trivial is associated with trochlear nerve palsies while forcible head trauma as in cases of RTA can lead to III & VI cranial nerve palsies. Careful examination and history taking of the patient is necessary. Radiological investigations should be carried out.,The imaging abnormalities may not correlate with a particular cranial nerve injury. Long term follow up of the patient is necessary.
| Item Type: | Thesis (Masters) |
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| Additional Information: | 221713011 |
| Uncontrolled Keywords: | Trauma, ocular motor nerve, trochlear nerve, abducent nerve, head injury, palsy, diplopia, ptosis, aberrant regeneration. |
| Subjects: | MEDICAL > Ophthalmology |
| Depositing User: | Subramani R |
| Date Deposited: | 14 Feb 2021 07:18 |
| Last Modified: | 14 Feb 2021 07:18 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/14166 |
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