Painful ophthalmoplegia is a clinical syndrome presenting with periorbital / hemi-cranial pain and ipsilateral ocular motor nerve palsies and can occur with numerous different diseases. In this study, the authors aimed to determine the final definite aetiology among patients with painful ophthalmoplegia after long-term follow-up. The data of 44 cases (16 females, 28 females) were examined. At initial diagnosis, subjects were scanned for benign and secondary aetiologies. During the follow-up period, data on clinical outcomes (relapse or progression), treatment responses, and final diagnoses were evaluated. In total, 49 episodes of painful ophthalmoplegia (44 patients) were evaluated. Secondary aetiologies were identified in 21 patients: benign / secondary tumours in 10, inflammatory in one, infectious in three, vascular in three, demyelinating disease in one, autoimmune in two, and drug-related cause in one. Benign aetiologies were found in 23 patients; 11 had Tolosa-Hunt syndrome, two had recurrent painful ophthalmoplegic neuropathy, and 10 with diabetic ophthalmoparesis. Of patients with benign / secondary tumours nine out of 10 were malignant, and seven died due to disease progression during the treatment process. Results of long-term follow-up show that painful ophthalmoplegia is a complex clinical condition with a range of broad differential diagnosis with malignant and benign aetiologies. The authors suggest a detailed clinical examination, imaging and long-term follow-up as essential for accurate diagnosis and treatment management.
Aetiology of painful ophthalmoplegia
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