====== Painful ophthalmoplegia ======

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===== Definition =====

Painful [[ophthalmoplegia]]: Pain and dysfunction of ocular motility (may be due to involvement of one or more of cranial nerves III, IV, V & VI).

===== Etiologies =====

1. intraorbital

a) inflammatorypseudotumor(idiopathicorbitalinflammation):

b) contiguous sinusitis

c) invasive fungal sinus infection producing orbital apex syndrome. 

see [[Rhino-Orbital-Cerebral Mucormycosis]].

d) mets

e) lymphoma

2. superior orbital fissure/anterior cavernous sinus

a) Tolosa-Huntsyndrome:

b) mets

c) nasopharyngeal Ca

d) lymphoma

e) herpes zoster

f) carotid-cavernous fistula

g) cavernous sinus thrombosis

h) intracavernousaneurysm

3. parasellar region

a) pituitaryadenoma

b) mets

c) nasopharyngeal Ca

d) [[sphenoid sinus mucocele]]

e) meningioma/chordoma

f) apical petrositis (Gradenigo’s syndrome): 

4. posterior fossa

a) p-commaneurysm

b) [[basilar artery aneurysm]](rare)

5. miscellaneous

a) diabeticophthalmoplegia

b) migrainousophthalmoplegia

c) cranial arteritis

d) tuberculous meningitis:maycauseophthalmoplegia,usuallyincomplete,mostoftenprimarily oculomotor nerve