Microvascular Non-Arteritic Ocular Motor Nerve Palsies—What We Know and How Should We Treat?

Abstract

Patients with isolated unilateral pupil-sparing third or isolated fourth or sixth nerve palsies over 50 years are often diagnosed with “microvascular extraocular palsies”. This condition and its management provoke divergent opinions. We review the literature and describe the incidence, pathology, clinical presentation, yield of imaging, and management. A retrospective diagnosis of exclusion has little practical use. We suggest a pragmatic approach to diagnosis, investigation, and management from initial presentation.

• Abducens
• cranial nerve
• microvascular ischaemia
• oculomotor
• trochlear

Acknowledgements

The authors thank Dr. Paul Riordan-Eva for detailed reading and helpful comments

Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.

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Supplementary Material available online

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