Supranuclear ophthalmoplegia

This disorder occurs because the brain is sending and receiving faulty information through the nerves that control eye movement. The nerves themselves are healthy.

People who have this problem often have progressive supranuclear palsy (PSP). This is a disorder that affects the way the brain controls movement.

Other disorders that have been associated with this condition include:

• Inflammation of the brain (encephalitis)
• Disease that causes areas deep in the brain, just above the spinal cord, to shrink (olivopontocerebellar atrophy)
• Disease of the nerve cells in the brain and spinal cord that control voluntary muscle movement (amyotrophic lateral sclerosis)
• Whipple disease (a condition that also causes malabsorption disorder of the small intestine as well as other symptoms)

People with supranuclear ophthalmoplegia are unable to move their eyes at will in all directions, especially looking upward.

Other symptoms may include:

• Mild dementia
• Stiff and uncoordinated movements like those of Parkinson disease
• Disorders associated with supranuclear ophthalmoplegia

The health care provider will perform a physical exam and ask about the symptoms, focusing on the eyes and nervous system.

Tests will be done to check for diseases linked with supranuclear ophthalmoplegia. Magnetic resonance imaging (MRI) might show shrinking of the brainstem.

Treatment depends on the cause and symptoms of the supranuclear ophthalmoplegia.

Outlook depends on the cause of the supranuclear ophthalmoplegia.

Progressive supranuclear palsy - supranuclear ophthalmoplegia; Encephalitis - supranuclear ophthalmoplegia; Olivopontocerebellar atrophy - supranuclear ophthalmoplegia; Amyotrophic lateral sclerosis - supranuclear ophthalmoplegia; Whipple disease - supranuclear ophthalmoplegia; Dementia - supranuclear ophthalmoplegia

Rucker JC, Lavin PJM. Neuro-ophthalmology: ocular motor system. In: Jankovic J, Mazziotta JC, Pomeroy SL, Newman NJ, eds. Bradley and Daroff's Neurology in Clinical Practice. 8th ed. Philadelphia, PA: Elsevier; 2022:chap 18.

Lavin PJM, Donahue SP, Longmuir RA. Disorders of supranuclear control of ocular motility. In: Yanoff M, Duker JS, eds. Ophthalmology. 5th ed. Philadelphia, PA: Elsevier; 2019:chap 9.14.

Ling H. Clinical approach to progressive supranuclear palsy. J Mov Disord. 2016;9(1):3-13. PMID: 26828211; PMC4734991. www.ncbi.nlm.nih.gov/pmc/articles/PMC4734991/.

Updated by: Amit M. Shelat, DO, FACP, FAAN, Attending Neurologist and Assistant Professor of Clinical Neurology, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY. Review provided by VeriMed Healthcare Network. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.