Presentation, treatment of painful ophthalmoplegia with normal cranial imaging

This retrospective study found that ocular diabetic neuropathy and benign Tolosa-Hunt syndrome accounted for most of the painful ophthalmoplegia seen in patients with normal cranial imaging.

The authors reviewed 58 consecutive cases of painful ophthalmoplegia with a normal cranial MRI from a single center.

Of these cases, 44.8 percent were diagnosed as ocular diabetic neuropathy, 46 percent as benign Tolosa-Hunt syndrome and 8.6 percent as ophthalmoplegic migraine.

Clinical presentations were similar between the groups, except for the age of onset, response to glucocorticoids and disease course. Nearly all patients with benign Tolosa-Hunt syndrome and ophthalmoplegic migraine had an immediate improvement in ocular motor function after initiation of glucocorticoid treatment, compared to only some patients with diabetic ophthalmoplegia.

While nearly all patients (95 percent) recovered completely, patients with ophthalmoplegic migraine recovered more rapidly. Furthermore, patients with ocular diabetic neuropathy were significantly older than those with benign Tolosa-Hunt syndrome or ophthalmoplegic migraine.