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Eye muscle weakness, also known as ophthalmoplegia, is a condition that affects the six muscles that control eye movement and contribute to vision. Ophthalmoplegia can be congenital or develop later in life and is generally caused by a disruption in the messages sent from the brain to the eyes. It can be associated with other systemic disorders, resulting in symptoms such as difficulty swallowing and general muscle weakness. Treatment options depend on the type of ophthalmoplegia, symptoms, and underlying cause. Adults may be prescribed special glasses or eye patches to alleviate double vision, while children born with this condition may compensate and not experience noticeable vision problems. In addition to ophthalmoplegia, eye muscle weakness can also be caused by increased screen time, leading to Computer Vision Syndrome or Digital Eye Strain. To prevent and manage eye strain, individuals can follow the 20-20-20 rule, which involves looking away from the screen every 20 minutes for 20 seconds and focusing on an object 20 feet away.
| Characteristics | Values |
|---|---|
| Name of the condition | Ophthalmoplegia |
| What it affects | Six muscles that hold the eye in place and control its movement |
| Types | Chronic progressive external ophthalmoplegia and internal ophthalmoplegia |
| Symptoms | Drooping eyelids, double vision, watery eyes, light sensitivity, pain between eyes and forehead, burning eyes, eye strain, headaches, blurred vision, difficulty swallowing, general muscle weakness, difficulty controlling the muscles that coordinate the eyes, inability to position the eyes in sync, difficulty moving both eyes in every direction |
| Causes | Nerve damage to nerve fibers that coordinate lateral eye movement, multiple sclerosis, trauma, infarction, muscle disorders, mitochondrial diseases, Graves' disease, Kearns-Sayre syndrome, diabetes, genetic and mitochondrial diseases, a history of vascular disease or stroke, genetic syndromes |
| Treatment | Special glasses, eye patch, treatment for migraines, steroids, immune therapy, surgical correction, botulinum toxin injections |
| Prevention | Eye exercises, following the 20-20-20 eye rule |
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What You'll Learn
Ophthalmoplegia
There are two main types of ophthalmoplegia: internal and external. Internal ophthalmoplegia refers to paralysis or weakness in one or more of the three internal muscles that help the eye focus and control pupil size. These muscles include the ciliary muscle, which changes the shape of the lens to focus on nearby or faraway objects, the dilator pupillae, which enlarges the pupil to let in more light, and the sphincter pupillae, which shrinks the pupil to let in less light. People with internal ophthalmoplegia may experience double or blurred vision, and they may have difficulty positioning both eyes in sync.
External ophthalmoplegia refers to a weakness or paralysis in one or more of the six muscles that work together to create eye movements. Chronic progressive external ophthalmoplegia typically appears in adults between the ages of 18 and 40 and begins with drooping eyelids and difficulty controlling the muscles that coordinate the eyes. External ophthalmoplegia is usually caused by muscle disorders or mitochondrial diseases.
There are other types of ophthalmoplegia as well. For example, supranuclear ophthalmoplegia refers to an affected brain area above the nuclei, and most people with this type suffer from progressive supranuclear palsy (PSP), a rare brain condition that leads to muscle weakness, walking issues, and other symptoms. Unilateral internuclear ophthalmoplegia affects one eye, while bilateral internuclear ophthalmoplegia affects both eyes.
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Myasthenia Gravis
The onset of myasthenia gravis can be sudden, and symptoms may not be immediately recognised as myasthenia gravis. The degree of muscle weakness varies among individuals. In some cases, the muscles that control breathing weaken to the point where a ventilator is required. This is called a myasthenic crisis and requires immediate emergency medical care. A myasthenic crisis may be triggered by infection, stress, surgery, or an adverse reaction to medication. Approximately 15-20% of people with myasthenia gravis experience at least one myasthenic crisis, and it is more common in young adult women under 40 and older men over 60.
While myasthenia gravis can affect individuals of any age, it is rarely seen in infants. In a condition called neonatal myasthenia, a fetus may acquire antibodies from the mother. However, neonatal myasthenia gravis is typically temporary, and the child's symptoms usually disappear within two to three months after birth. Although myasthenia gravis is not inherited or contagious, it may occasionally occur in multiple members of the same family.
Ophthalmoplegia, or weakness of the eye muscles, can be a symptom of myasthenia gravis. It can affect one or more of the six muscles that hold the eye in place and control its movement, leading to double vision and difficulty controlling eye coordination. Treatment for ophthalmoplegia aims to target the root cause and ease symptoms, including double vision, through various methods such as steroids, immune therapy, surgical correction, and botulinum toxin injections.
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Computer Vision Syndrome
Eye muscle weakness can be caused by spending long periods staring at a screen, such as a computer or smartphone. This phenomenon is known as Computer Vision Syndrome (CVS) or digital eye strain.
CVS is a cluster of eye and vision-related issues caused by prolonged use of digital devices. It is not a specific problem but rather a range of eye strains and discomfort. Research suggests that between 50% and 90% of people who work at a computer screen experience some symptoms of CVS. It is not limited to working adults, as children who use tablets or computers can also be affected, especially if lighting and posture are inadequate.
The symptoms of CVS include eye strain, dry eyes, blurred vision, and headaches. The eyes work harder when viewing a computer or digital screen compared to reading from a printed page. The letters on a screen are often less precise, with reduced contrast, and the presence of glare and reflections can make viewing more challenging. The viewing distances and angles used for screen work are also typically different from those used for reading or writing on paper. As a result, the eye-focusing and eye-movement requirements for screen viewing place additional demands on the visual system.
To alleviate digital eye strain, it is recommended to follow the 20-20-20 rule: for every 20 minutes spent looking at a screen, take a 20-second break and focus on an object at least 20 feet away. Additionally, ensuring that any computer or digital device is set up at the right height and in good lighting can help prevent CVS. Regular eye examinations are also important, and an eye doctor can advise on whether glasses or contact lenses are needed for screen work.
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Digital Eye Strain
The symptoms of Digital Eye Strain are caused by the unique demands of viewing digital screens. The letters on a screen are often not as sharply defined as printed text, and the level of contrast between the letters and the background is reduced. Glare and reflections on the screen can also make viewing difficult. Additionally, the viewing distances and angles used for screen time are often different from those used for reading or writing, placing additional demands on the visual system.
The average American worker spends seven hours a day on the computer, either in the office or working from home. The COVID-19 pandemic has further increased screen time, with digital learning and video conferencing becoming the norm. As a result, the prevalence of Digital Eye Strain has risen, affecting individuals of all ages.
To alleviate Digital Eye Strain, several management options can be implemented. These include reducing daily screen time, improving lighting and minimizing glare, taking regular breaks from the screen, and following the 20-20-20 rule: for every 20 minutes spent looking at a screen, look away for 20 seconds at an object 20 feet away.
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Eye Movement Disorders
Strabismus
Strabismus, also known as "crossed eyes" or "walleye", is a disorder in which the two eyes do not line up in the same direction. It can be present at birth or develop later in childhood or adulthood. Treatment options for strabismus include glasses, patches, eye muscle exercises, and surgery.
Nystagmus
Nystagmus is characterised by fast, uncontrollable movements of the eyes, sometimes referred to as "dancing eyes". The eyes can jerk in one direction or make back-and-forth movements, and nystagmus can affect one or both eyes. It can be constant or intermittent and occur in various directions, including horizontal, vertical, oblique, and circular motions or combinations of these. There is currently no cure for most kinds of nystagmus.
Ophthalmoplegia
Ophthalmoplegia is the paralysis or weakness of the eye muscles, affecting one or more of the six muscles that hold the eye in place and control its movement. It can be caused by nerve damage to the nerve fibres that coordinate lateral eye movement, resulting in double vision. Ophthalmoplegia can be internal or external. Internal ophthalmoplegia refers to the weakness or paralysis of the three internal muscles that help the eye focus and control pupil size, while external ophthalmoplegia involves the six muscles that work together to create eye movements. Treatment for ophthalmoplegia depends on the type, symptoms, and underlying cause, with options including glasses, eye patches, steroids, immune therapy, surgery, and botulinum toxin injections.
In addition to the above, other eye movement disorders include amblyopia, cranial mononeuropathy III, progressive supranuclear palsy (PSP), and conjugate gaze palsies.
The diagnosis and treatment of eye movement disorders involve various techniques and specialists. Eye movement disorders can be identified through sophisticated testing methods, including computer technology, video recording, and genetic testing. Treatment options may include surgery, glasses, patches, and eye muscle exercises, among others.
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Frequently asked questions
Eye muscle weakness, or ophthalmoplegia, is the paralysis or weakness of one or more of the six muscles that control eye movement and hold the eye in place.
Ophthalmoplegia is generally caused by a disruption of the messages sent from the brain to the eyes. It can also be caused by nerve damage to the nerve fibers that coordinate lateral eye movement. External ophthalmoplegia is usually caused by muscle disorders or mitochondrial diseases, while internal ophthalmoplegia is often caused by multiple sclerosis, trauma, or infarction.
Symptoms of ophthalmoplegia include double or blurred vision, drooping eyelids, and difficulty moving the eyes in every direction or keeping them in sync. Other symptoms include watery eyes, light sensitivity, pain between the eyes and forehead, burning eyes, eye strain, and headaches.
Treatment for ophthalmoplegia depends on the type, symptoms, and underlying cause. Children born with this condition often learn to compensate and may not be aware of their vision problems. Adults may be prescribed special glasses or an eye patch to assist with double vision. In some cases, treatments for migraines or steroids and immune therapy can improve outcomes.
If you are experiencing any sudden changes in eye movement control or vision, you should seek immediate medical attention. Skull fractures and injuries to the head or face can affect eye muscle movement and are considered medical emergencies.
