The oculomotor nerve belongs to the group of mixed nerves. It consists of motor and parasympathetic fibers. It is due to the oculomotor nerve that the raising, lowering, turning and other movements of the eyeball are carried out. But his role is much more important and is not only that. This nerve, which is a necessary functional component for the normal operation of the visual analyzer, also provides normal eyelid movements and the pupil's response to light.
Damage to the oculomotor nerve: symptoms, main manifestations
It is worth noting that isolated violation of this nerve is very rare. Here are the main symptoms:
- immobility of the muscle of the upper eyelid and, as a consequence, its partial or complete omission;
- lack of resistance for the upper oblique and lower rectus muscles, as a result of which divergent strabismus can be diagnosed;
- immobility of the internal rectus muscle and, as a consequence, the occurrence of the phenomenon of double vision (diplopia) ;
- lack of reaction of the pupil to light;
- violation of the innervation of the internal muscle and, as a result, the inability of the eye to adapt to objects located at different distances from it;
- the absence of contraction of the rectus muscles of both eyes, which makes it impossible to turn the eyeballs inward;
- protrusion of the eyes due to loss of tone of the external muscles, this confirms that there was a lesion of the oculomotor nerve.
Most often, all of these symptoms are combined with concomitant manifestations that cause impaired functioning of the friendly nerve fibers that are adjacent to muscle groups and organs.
Diagnostic Features
If all the fibers of the oculomotor nerve are affected, then the manifestation of this is so obvious that the diagnosis is not in doubt. First of all, it is ptosis (prolapse of the upper eyelid), dilated pupil, deviation of the eyeball outward and downward.
However, various combinations of ptosis and dilated pupil, as well as any other disorders caused by muscle paresis, are very common. In such cases, we can talk about both the primary stage of damage to the fibers of the oculomotor nerve, and other possible violations of the accompanying organs. Making a timely and accurate diagnosis in such cases is much more difficult.
Causes of the lesion, the role of timely diagnosis and treatment
The main causes of damage to the oculomotor nerve are:
- injuries
- neuroinfectious diseases;
- brain tumors of various etiologies;
- cerebral vascular pneumism;
- diabetes;
- stroke.
However, most often, the causes of partial or complete damage to the nuclei or fibers of the oculomotor nerve remain only an assumption. It is impossible to establish them exactly. The human body is a very complex system, and it has not been fully studied yet, but it is absolutely known that a malfunction of one of its components in a chain transfers this to other organs, nerves and muscles.
For example, neuropathy of the oculomotor nerve in an isolated form is very rare and most often it is a concomitant manifestation of chronic or congenital diseases, as well as being the result of traumatic brain injuries and tumors. With proper and timely treatment, this disease can go away without complications and consequences.
If neuropathy of the oculomotor nerve is suspected, it is necessary to take a whole course of tests, including blood for the presence of neuroinfection in the body. Only after receiving the results and confirming the diagnosis, it is possible to prescribe a course of treatment and be sure to repeat the tests.
Diagnosis of the disease
If there is a suspicion of a violation of the function of the oculomotor nerve, it is possible to confirm or deny it, as well as to identify the real cause of the deviation, only by conducting high-quality professional diagnostics. Most often this is done by an ophthalmologist, and only in some cases, if the diagnosis is in doubt, an appointment with a neurologist is additionally prescribed.
Diagnosis and examination of the organs of vision is carried out on modern computer equipment, as well as through a variety of specialized tests. As a result, after their comprehensive conduct, the patient can be diagnosed.
Also, in addition to standard procedures for checking the condition of the fundus, determining the quality of vision, eye mobility, detecting pupil reactions to light, MRI and angiography are performed. If the etiology is not fully revealed, and even if the damage to the oculomotor nerve is confirmed, constant monitoring of the patient, as well as repeated examinations, are mandatory.
Constant monitoring of the condition of the affected organ is a prerequisite for treatment
This is very important, because the timely detection of further progression of the disease, as well as the constant monitoring of the treatment prescribed by the doctor, are of great importance for the entire condition of the eye and all further human life. So, for example, oculomotor nerve neuritis in most cases has a positive trend if the patient complies with all the requirements, however, treatment is carried out only with the constant supervision of specialists.
Science does not stand still, and recently one of the innovative diagnostic methods is superpositional electromagnetic scanning of the oculomotor muscles to assess their functional activity. Thanks to this method, the time taken to identify the cause of the violation is significantly reduced, and it becomes possible to start treatment much faster and achieve positive results.
The most effective treatments
As soon as there is a suspicion of a possible violation of the functions of the oculomotor nerve, the patient is immediately recommended to do exercises to strengthen the muscle responsible for the movement of the organs of vision. Of course, it’s not bad to try to strengthen it as much as possible, and not only when problems appeared, but even for prevention, but this is suitable only at the very beginning of the violation. If a rather large part is already affected, these exercises will not help to recover, although they are an integral part of the treatment.
The next most common recommendation is to take appropriate vitamins and medications, the action of which is also aimed at strengthening the eye muscle and restoring its work. It can be special vitamins, eye drops, glasses, dressings that make the sick eye work more actively.
Special computer programs are very popular today. Basically, these are the so-called stereo images.
The use of computer programs in the treatment of disorders of the eye muscle
It is proved that when viewing such pictures, the eye muscles train, and, accordingly, blood circulation in them improves. At this time, the nerves responsible for the normal functioning of the eye are in a heightened state of stress, and all the reserves of the body are aimed at controlling them, because most of the other organs at the time of viewing are in a relaxed state and do not require such attention.
Stereo images really have a very positive result for vision, but they can only be used after consultation with a doctor. Indeed, in some cases they are just a panacea, and in others they can cause irreparable harm.
Modern treatments
If, after several mutually complementary diagnostics, it is confirmed that the oculomotor nerve is affected, treatment should be started without delay. One of the proven ones on the positive side and used in practical ophthalmology for several years is the treatment of 1.5% of neuromidine with the help of electrophoresis of the affected areas.
It is carried out by applying three circular electrodes with different squares, the two smaller of which are placed on the skin of the orbital region and upper eyelids with eyes closed. They are connected by a bifurcated wire with an electrode of a larger area, which is located in the cervical-occipital region of the patient's head.
The duration of this procedure with a course of treatment of up to 15 sessions conducted daily is 15-20 minutes. The method allows locally and purposefully acting on defective neuromuscular synapses of the eyeball, as well as nuclear structures of the oculomotor nerves.
When surgery is necessary
In the vast majority of cases, surgical surgery is performed. It is aimed at eliminating the cause of the disease. In most cases, thanks to the capabilities of modern medicine, operations are performed under local anesthesia, and it turns out that the patient is not hospitalized.
Any disturbances in the function of the eye muscle and various degrees of damage to the oculomotor nerve lead to rather serious consequences. If one eye begins to see poorly, the second tries as much as possible to compensate for this violation. If ptosis begins to develop, the nearby muscles for some time perform eyelid lift on their own. That is why from the very birth of a child it is recommended to undergo regular examination by an ophthalmologist and in no case do not miss them. This is very important, because only prevention and timely diagnosis guarantees the most optimal treatment outcome.