Oculomotor Nerve Palsy (Third Cranial Nerve)

I've been going over my symptoms lately...Hey, I figured someone should, since most of my doctors want me to wait and see what happens. One of my newest symptoms is an upper droopy eyelid. This symptom appeared late last year. I also suffer with double vision. At the beginning of 2008, I went to an opthamologist who thought I had double vision due to eye muscle weakness that lines up the eyes. It was also noted that my left eye...(the one that later developed the droopy upper eyelid) had a sluggish response to light. It did not constrict as fast as the right.

All the symptoms (double vision caused by eye muscle weakness, sluggish pupil response, droopy upper eyelid) is connected to the third cranial nerve. All these symptoms come and go. I will experience symptoms worse for days and then it will disappear. It seems to be worse when I'm in one of my many "episodes", otherwise it is barely noticeable on some days or some days, everything is fine.

I've read that you could get oculomotor nerve palsy and it does fit some of my symptoms but if I do have it...it would have to be a mild form so far, because I have never experienced not being able to move my eye around in all directions. They just feel really "weak" if I try to look at something from the side rather than straight ahead. It is only slightly effected. I'm thinking the cranial nerve is being damaged/effected and I haven't experienced the full fledged palsy...if you know what I mean.

Does anyone know about this or has experience with this? Do you think it is possible to have a mild form? I was tested for Myathenia Gravis and that was negative. It just seems funny that all of my symptoms can be connected to one nerve and it makes since that something must be going on with the third cranial nerve...So why doesn't the doctors see it and want to investigate more in to it and it's cause?

[Wobbly]

Have you had a VEP done?  I have double vision with both eyes ...and my left eyelid seems to droop more then before..(but I don't know if that just old age).. sorry, can't help with the question though...

take care
wobbly
undx

[slightlybroken]

Yes, I had a VEP done in Aug. of last year. That came up within normal levels from what they said. The left eye did have a little difference in the results..but was still within normal limits.

[Quixotic1]

I just want to explain something.  The VEP will not test or show specific results for double vision.

Double vision has to do with the muscles that allow the eye to move around.  There are six main muscles for each eye.  They allow the eye to move up, down and side-to-side.  They also allow the eye to look on the diagonals in between.  By working together they allow smooth movement in all directions.

The muscles of both eyes have to be equally strong to allow perfect stereoscopic vision.

These muscles are innervated by three cranial nerves, III, IV, and VI.   These nerves all come off the brainstem and are part of the Central Nervous System.  The Oculomotor Nerve is the third cranial nerve and is the most important.

These nerves also cross communicate via nuclei (think of trnasit hubs) in the brainstem.

MS can affect whether the eyes move together by having a lesion on one of the three cranial nerves or by affecting one or more of the nuclei.

You can have perfect vision in an eye and still have double vision.  Vision is a product of the eye itself.  The image lands on the cornea (window) falls to the lens (the focuser) and then through the inside of the eye to the retina.  The retina is all the nerve endings receptors of the optic nerve.  The optic nerve is the second cranial nerve.  The optic nerve carries the image to the parts of the brain that process it into the image that we percieve.

When MS affects the optic nerve we get distortions or blanks in our image.

So the muscles align our eyes and the optic nerves carry the visual image.  If the eyes aren't aligned it does affect our being able to see a single image, but does not affect the vision in the eye.  So, the VEP is not the test to use when someone is seeing double.

So, Visually Wonky, you are completely correct about the Oculomotor nerve, but your problem may also include one of the other two nerves that affect your eyes moving together (IV or VI).  And, Yes, you may have a very minor palsy (weakness) and be able to overcome it.  It will usually show up more when you are generally fatigued or if you fatigue the eye muscles themselves like when playing a rapidly moving video game - like Tetris.

Does this help?

Quix

[Wobbly]

Thanks for the info...it explains alot and now I know this before I get my VEP results, you are so full of great wisdom...thanks again

wobbly
undx

[singinalong]

Great information !!! I have a really off the wall question though... besides the optic nerve, what part of the brain or spine ( or is there ) does the lesions have to show??? Or does it matter?
Crazy question I know, But, I am getting this " well we think its MS, but your symptoms dont corolate with where the "white spots " are???

Shari

[Quixotic1]

Hi, again!

I get so angry when docs think that the MRI shows every last one of all the lesions that are possibly there!  We just had this discussion on the "MS Hug" post.  It is ridiculous to aasume that every lesion correlates perfectly with a symptom.  It is equally ridiculous to assume that every symptom will have a visible MRI lesion to point to.  The MRIs are just not that perfect.

Please read the Health Page called "Lesions vs Symptoms."  I tried to discuss why lesions don't always equal symptoms and vice versa.

You may need to pursue a second or third opinion if your currecnt docs are stymied by the two things not matching.

With regard to the optic nerve:  The MS lesion (site of damage) can occur any where along the entire optic nerve all the way back along the more diffuse visual pathways in the brain the visual cortex where the image is analyzed by the "thinking" part of the brain.  If the vision is affected then we know there is a lesion, whether we "see" it or not.

When I developed Trigeminal Neuralgia we did an MRI to look for a brainstem lesion.  None was visible.  My neuro said, "Well, I don't see a lesion causing your TN.  That's good, because no one wants a big lesion on their brainstem."  He was acknowledging that a lesion MUST exist or I wouldn't be having the pain.  He didn't care that it was invisible to MRI. He was also saying that, by the time it is visible, it is already a "big" lesion.  Those are important points to remember.

Hope this helps.  I recommend that you read that Health Page.

Quix

[young at heart]

ALL,

I'VE HAD VEPS, YES,THEY ARE ABNORMAL!!!!  VISIAL DISTORTION,DIMMED CLORS,BLURRY,IT'S BEEN LIKE THAT FOR A YEAR.

THE MRI'S THEY CAN TAKE AND WAD UP AND PUT THEM WHERE THE SUN DON'T SHINE.

A VNG,---HIGH TECH DONE BY MY NEURO-OTOLOGIST(WRONG SPELLING).HE REPEATED THIS TEST 3 TIMES,SEVERE OCULAR MOTOR DISORDER.MY EYES DON'T TRACK,THEY HAVE LIMITED MOVEMENT.

MRI'S MISS TO MUCH,THESE DRS HAVE THE AVAILABILITY TO DO OTHER TEAT THAN MRI'S TO GET RESULTS.

THERES DAYS I COULD TAKE SOME OF THESE DRS AND LET THEM LIVE IN MY BODY,THEN THEY'D REALIZE THAT THE MRI SHOULD NOT BE WEIGHED HEAVILY IF THE IMAGES COME BACK NORMAL.

MY VNG REPORT PUT ME OVER THE EDGE,WHEN IT CAME BACK WITH THE BALANCE CORTEX BEING FLAT-LINED AND THE OCULAR MOTOR DYSFUNCTION
MY EYES ARE LIMITED MOVING TOGETHER,THEY HAVE DIFFICULTY MOVING UP AND DOWN,BACK AND FORTH AND THEY DON'T ROTATE(YA KNOW WHEN YOUR KID ROLLS THEIR EYES)IF I TRY THEY GET STUCK!!!!

EYE DR.---JUST A STANDARD OICK RIGHT UP ON THE MUSCLE ASPECT,GONNA PUT PRISMS IN THE LENSES TO HELP THE DOUBLE VISION.

HANG IN THERE.

T-LYNN

[slightlybroken]

Thanks for all the input...

Quix...as always...thanks for explaining. My question now is....How do I get a doctor to see and investigate into what I just found? How come they aren't putting the pieces together? This is a fairly new symptom (the droopy upper eyelid) so why not repeat an MRI of the brain. The droopy upper eyelid, eye muscle weakness, and sluggish pupil constriction is all connected to the cranial nerves so why not check on it since one more symptom has been added to the list? I just don't get it!

T-LYNN- I LIKE WHAT YOU SAID ABOUT STICKING THE MRIS WHERE THE SUN DOESN'T SHINE...I HAD A GIGGLE AT THAT ONE...I FEEL THAT STATEMENT. BELIEVE ME! I'M TIRED OF TRYING TO FIND ANSWERS THAT I CARE SO MUCH ABOUT, AND THE DOCTORS CARE SO LITTLE.

[singinalong]

little detour here...
I was reading somewhere, that optic neuritis only lasts for a while, and then it gets better then comes back etc... is this true??? Or can it last until med are administered, then get better??

another quacky question from yours truely !!! :)

[slightlybroken]

ON (optical neuritis) can get better on it's own without the use of treatment. Steroids are used  to help you recover your vision faster by reducing the inflammation of the optical nerve. Steroids will not fix the damage caused by ON.

lol there's no such thing as a quaky question :)

[singinalong]

Sooooo then.... Could a person have ON for months at a time? Then get better? The opthomologist seems to think I could possibly have ON, but he didnt see anything through his tests... He thinks it could be in the brain somewhere... like a nerve close to the optic nerve... or pressure or something... I am rambling ...

[slightlybroken]

ON can be seen on exam but if it has occurred further back on the optical nerve it wouldn't be pick up on the exam that an opthamologist does. They would have to do an MRI to see that damage. The optical nerve runs from the eye all the way through the brain to the occipital part of the brain where the vision center is. ON can occur anywhere on the nerve.

It is possible to suffer with ON for months and then recover. Have you had a VEP?..that would detect damage or lesions caused by ON even if they aren't seen on MRI. That would be the next test I would push for.

[singinalong]

I had a VEP done, back in November, I believe it was "normal" for what I was told. I just talked to the opthomoligists office, and I am getting referred to a neuro opthomoligist!! WHOOO HOOOO!!!!
Sorry, about the detour