Skip to main content
SpringerLink
Log in

Okulomotorik und multiple Sklerose

Oculomotor system and multiple sclerosis

  • Leitthema
  • Published:
Der Ophthalmologe Aims and scope Submit manuscript

Zusammenfassung

Störungen der Augenmotilität im Rahmen der multiplen Sklerose können zu erheblichen Symptomen wie verschwommenem Sehen, Diplopie, Oszillopsien und Schwindel führen. Das Spektrum an okulomotorischen Störungen ist aufgrund der multifokalen Natur der Erkrankung sehr breit. Zu den häufigsten Defiziten gehören Störungen von Sakkaden und Folgebewegungen, die internukleäre Ophthalmoplegie, Störungen des vestibulookulären Reflexes, eine Heterotropie, eine eingeschränkte Konvergenz und ein Blickrichtungsnystagmus. Das Ausmaß der Störung der Augenmotilität korreliert häufig mit der Gesamtbehinderung des Patienten, da sowohl die Augenmotilität als auch die Gehfähigkeit durch eine ausgeprägte Beteiligung von Hirnstamm und Kleinhirn beeinträchtigt werden.

Abstract

Disorders of ocular motility due to multiple sclerosis can cause significant symptoms, such as blurred vision, diplopia, oscillopsia and dizziness. The spectrum of ocular motor disorders is broad due to the multifocal nature of the disease. The most frequent disorders include dysmetric saccades, impaired smooth pursuit, internuclear ophthalmoplegia (INO), impaired vestibulo-ocular reflex, misalignment of visual axes, impaired vergence and gaze-evoked nystagmus. Patients with abnormal eye movements are more handicapped than patients without ocular motility disorders as eye movement disorders and gait disturbances are both caused by an extensive involvement of the brainstem and cerebellum.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Literatur

  1. Adams WE, Leavitt JA, Holmes JM (2009) Strabismus surgery for internuclear ophthalmoplegia with exotropia in multiple sclerosis. J AAPOS 13:13–15

    Article  PubMed Central  PubMed  Google Scholar 

  2. Aschoff JC, Conrad B, Kornhuber HH (1974) Acquired pendular nystagmus with oscillopsia in multiple sclerosis: a sign of cerebellar nuclei disease. J Neurol Neurosurg Psychiatry 37:570–577

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  3. Barnes D, McDonald WI (1992) The ocular manifestations of multiple sclerosis. 2. Abnormalities of eye movements. J Neurol Neurosurg Psychiatry 55:863–868

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  4. Barton JJ, Cox TA (1993) Acquired pendular nystagmus in multiple sclerosis: clinical observations and the role of optic neuropathy. J Neurol Neurosurg Psychiatry 56:262–267

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  5. Berlit P, Reinhardt-Eckstein J, Krause K-H (1988) Die isolierte Abducensparese – Eine retrospektive Studie an 165 Patienten. Fortschr Neurol Psychiat 56:32–40

    Google Scholar 

  6. Bolanos I, Lozano D, Cantu C (2004) Internuclear ophthalmoplegia: causes and long-term follow-up in 65 patients. Acta Neurol Scand 110:161–165

    Article  CAS  PubMed  Google Scholar 

  7. Crevits L, Venhovens J, Vanoutrive J, Debruyne J (2007) False perception of visual verticality in multiple sclerosis. Eur J Neurol 14:228–232

    Article  CAS  PubMed  Google Scholar 

  8. Davis SL, Frohman TC, Crandall CG et al (2008) Modeling Uhthoff’s phenomenon in MS patients with internuclear ophthalmoparesis. Neurology 70:1098–1106

    Article  CAS  PubMed  Google Scholar 

  9. Downey DL, Stahl JS, Bhidayasiri R et al (2002) Saccadic and vestibular abnormalities in multiple sclerosis: sensitive clinical signs of brainstem and cerebellar involvement. Ann N Y Acad Sci 956:438–440

    Article  PubMed  Google Scholar 

  10. Frohman EM, Frohman TC, O’Suilleabhain P et al (2002) Quantitative oculographic characterisation of internuclear ophthalmoparesis in multiple sclerosis: the versional dysconjugacy index Z score. J Neurol Neurosurg Psychiatry 73:51–55

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  11. Frohman TC, Graves J, Balcer LJ et al (2010) The neuro-ophthalmology of multiple sclerosis. Continuum (Minneap Minn) 16:122–146

  12. Graves J, Balcer LJ (2010) Eye disorders in patients with multiple sclerosis: natural history and management. Clin Ophthalmol 4:1409–1422

    PubMed Central  PubMed  Google Scholar 

  13. Halmagyi GM, Gresty MA (1979) Clinical signs of visual-vestibular interaction. J Neurol Neurosurg Psychiatry 42:934–939

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  14. Jacobson DM, Moster ML, Eggenberger ER et al (1999) Isolated trochlear nerve palsy in patients with multiple sclerosis. Neurology 53:877–879

    Article  CAS  PubMed  Google Scholar 

  15. Jasse L, Vukusic S, Durand-Dubief F et al (2013) Persistent visual impairment in multiple sclerosis: prevalence, mechanisms and resulting disability. Mult Scler 19:1618–1626

    Article  PubMed  Google Scholar 

  16. Jenkins PF (2007) The multiple facets of multiple sclerosis. Am Orthopt J 57:69–78

    Article  PubMed  Google Scholar 

  17. Jozefowicz-Korczynska M, Pajor AM (2011) Evaluation of the smooth pursuit tests in multiple sclerosis patients. J Neurol 258:1795–1800

    Article  PubMed  Google Scholar 

  18. Keane JR (1976) Bilateral sixth nerve palsy. Analysis of 125 cases. Arch Neurol 33:681–683

    Article  CAS  PubMed  Google Scholar 

  19. Lee WB, Berger JR, O’Halloran HS (2003) Parinaud syndrome heralding MS. Neurology 60:322

    Article  PubMed  Google Scholar 

  20. Leigh RJ, Serra A (2008) Taking the temperature of MS with INO. Neurology 70:1063–1064

    Article  PubMed  Google Scholar 

  21. Lemos J, Eggenberger E (2013) Saccadic intrusions: review and update. Curr Opin Neurol 26:59–66

    Article  CAS  PubMed  Google Scholar 

  22. Lopez LI, Bronstein AM, Gresty MA et al (1996) Clinical and MRI correlates in 27 patients with acquired pendular nystagmus. Brain 119(Pt 2):465–472

    Article  PubMed  Google Scholar 

  23. Mastaglia FL, Black JL, Collins DW (1979) Quantitative studies of saccadic and pursuit eye movements in multiple sclerosis. Brain 102:817–834

    Article  CAS  PubMed  Google Scholar 

  24. Meienberg O, Muri R, Rabineau PA (1986) Clinical and oculographic examinations of saccadic eye movements in the diagnosis of multiple sclerosis. Arch Neurol 43:438–443

    Article  CAS  PubMed  Google Scholar 

  25. Muri RM, Meienberg O (1985) The clinical spectrum of internuclear ophthalmoplegia in multiple sclerosis. Arch Neurol 42:851–855

    Article  CAS  PubMed  Google Scholar 

  26. Murthy R, Dawson E, Khan S et al (2007) Botulinum toxin in the management of internuclear ophthalmoplegia. J AAPOS 11:456–459

    Article  PubMed  Google Scholar 

  27. Pieh-Beisse C, Lagreze WA (2011) Pharmacological treatment of nystagmus. Ophthalmologe 108:178–182

    Article  CAS  PubMed  Google Scholar 

  28. Pierrot-Deseilligny C (2011) Nuclear, internuclear, and supranuclear ocular motor disorders. Handb Clin Neurol 102:319–331

    Article  PubMed  Google Scholar 

  29. Proudlock FA, Gottlob I, Constantinescu CS (2002) Oscillopsia without nystagmus caused by head titubation in a patient with multiple sclerosis. J Neuroophthalmol 22:88–91

    Article  PubMed  Google Scholar 

  30. Rabinovitch HE, Sharpe JA, Sylvester TO (1977) The ocular tilt reaction. A paroxysmal dyskinesia associated with elliptical nystagmus. Arch Ophthalmol 95:1395–1398

    Article  CAS  PubMed  Google Scholar 

  31. Reulen JP, Sanders EA, Hogenhuis LA (1983) Eye movement disorders in multiple sclerosis and optic neuritis. Brain 106(Pt 1):121–140

    Article  PubMed  Google Scholar 

  32. Richards BW, Jones FR Jr, Younge BR (1992) Causes and prognosis in 4,278 cases of paralysis of the oculomotor, trochlear, and abducens cranial nerves. Am J Ophthalmol 113:489–496

    CAS  PubMed  Google Scholar 

  33. Roodhooft JM (2012) Summary of eye examinations of 284 patients with multiple sclerosis. Int J MS Care 14:31–38

    Article  PubMed Central  PubMed  Google Scholar 

  34. Schon F, Hodgson TL, Mort D, Kennard C (2001) Ocular flutter associated with a localized lesion in the paramedian pontine reticular formation. Ann Neurol 50:413–416

    Article  CAS  PubMed  Google Scholar 

  35. Serra A, Derwenskus J, Downey DL, Leigh RJ (2003) Role of eye movement examination and subjective visual vertical in clinical evaluation of multiple sclerosis. J Neurol 250:569–575

    Article  PubMed  Google Scholar 

  36. Sharpe JA, Goldberg HJ, Lo AW, Herishanu YO (1981) Visual-vestibular interaction in multiple sclerosis. Neurology 31:427–433

    Article  CAS  PubMed  Google Scholar 

  37. Subei AM, Eggenberger E (2012) Efferent manifestations of multiple sclerosis. Curr Opin Ophthalmol 23:506–509

    Article  PubMed  Google Scholar 

  38. Thomke F, Lensch E, Ringel K, Hopf HC (1997) Isolated cranial nerve palsies in multiple sclerosis. J Neurol Neurosurg Psychiatry 63:682–685

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  39. Tilikete C, Jasse L, Vukusic S et al (2011) Persistent ocular motor manifestations and related visual consequences in multiple sclerosis. Ann N Y Acad Sci 1233:327–334

    Article  CAS  PubMed  Google Scholar 

  40. Toosy AT, Mason DF, Miller DH (2014) Optic neuritis. Lancet Neurol 13:83–99

    Article  CAS  PubMed  Google Scholar 

  41. Tsuda H, Ishikawa H, Matsunaga H, Mizutani T (2004) A neuro-ophthalmological analysis in 80 cases of multiple sclerosis. Rinsho Shinkeigaku 44:513–521

    PubMed  Google Scholar 

  42. Tsutsumi T, Murakami M, Kawaishi J et al (2009) Ocular flutter associated with a lesion of the right upper pontine tegmentum. Auris Nasus Larynx 36:695–697

    Article  PubMed  Google Scholar 

  43. Versino M, Colnaghi S, Callieco R et al (2002) Vestibular evoked myogenic potentials in multiple sclerosis patients. Clin Neurophysiol 113:1464–1469

    Article  PubMed  Google Scholar 

  44. Zadro I, Barun B, Habek M, Brinar VV (2008) Isolated cranial nerve palsies in multiple sclerosis. Clin Neurol Neurosurg 110:886–888

    Article  PubMed  Google Scholar 

  45. Zwergal A, Cnyrim C, Arbusow V et al (2008) Unilateral INO is associated with ocular tilt reaction in pontomesencephalic lesions: INO plus. Neurology 71:590–593

    Article  CAS  PubMed  Google Scholar 

Download references

Einhaltung ethischer Richtlinien

Interessenkonflikt. A.E. Höh und C. Beisse geben an, dass kein Interessenkonflikt besteht. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

Author information

Authors and Affiliations

  1. Universitäts-Augenklinik Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Deutschland

    A.E. Höh & C. Beisse

Authors
  1. A.E. Höh
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. C. Beisse
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to A.E. Höh.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Höh, A., Beisse, C. Okulomotorik und multiple Sklerose. Ophthalmologe 111, 727–732 (2014). https://doi.org/10.1007/s00347-013-2985-9

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00347-013-2985-9

Schlüsselwörter

Keywords

Search

Navigation