Contributor: Gordon K. Klintworth
Ophthalmoplegia is a manifestations of numerous syndromes. Ophthalmoplegia may be congenital [ophthalmoplegia - congenital] or acquired and it may involve the extraocular muscles [ophthalmoplegia - external] or the intraocular muscles [ophthalmoplegia - internal]. The many causes include lesions involving  pathways in the central nervous system, which may be in the brain stem between the nuclei of the motor nerves of the eye [ophthalmoplegia - internuclear] or in parts of the brain above these nuclei [ophthalmoplegia - supranuclear]. Botulism is a life threatening cause ophthalmoplegia. Causes of a painful ophthalmoplegia include aneurysms of the posterior communicating artery, basilar artery, trauma, a carotid cavernous fistula, cavernous sinus fustula, infection, inflammatory disorders [Tolosa-Hunt syndrome, giant cell arteritis], ischemic disorders [diabetes mellitus, hypertension], and ophthalmoplegic migraine [migraine - ophthalmoplegic].