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An approach to the patient with painful ophthalmoplegia, with a focus on Tolosa-Hunt syndrome

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Abstract

The differential diagnosis of painful ophthalmoplegia is extensive and consists of numerous sinister etiologies, including neoplasms (ie, primary intracranial tumors, local or distant metastases), vascular (eg, aneurysm, carotid dissection, and carotid-cavernous fistula), inflammatory (ie, orbital pseudotumor, giant cell arteritis, sarcoidosis, and Tolosa-Hunt syndrome), and infectious etiologies (ie, fungal and mycobacterial), as well as other miscellaneous conditions (ie, ophthalmoplegic migraine and microvascular infarcts secondary to diabetes). A systematic approach to the evaluation of painful ophthalmoplegia can lead to prompt recognition of serious disorders that can be associated with significant morbidity or mortality if left untreated. Inflammatory conditions such as Tolosa-Hunt syndrome and orbital pseudotumor are highly responsive to corticosteroids but should be diagnoses of exclusion.

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  1. Gladstone Headache Clinic, 1333 Sheppard Avenue East, Suite 122, Toronto, Ontario, M2J 1V1, Canada

    Jonathan P. Gladstone MD, FRCPC

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  1. Jonathan P. Gladstone MD, FRCPC
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Correspondence to Jonathan P. Gladstone MD, FRCPC.

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Gladstone, J.P. An approach to the patient with painful ophthalmoplegia, with a focus on Tolosa-Hunt syndrome. Current Science Inc 11, 317–325 (2007). https://doi.org/10.1007/s11916-007-0211-7

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