Any process that affects ability of eyes to move in a coordinated fashion
Can be due to cranial nerve issue: e.g. stroke, tumor, mass impinging on CN3, 4 or 6; invasive infections (fungal, bacterial) causing cavernous sinus thrombosis
Can be due to NMJ or muscle issue: e.g. myasthenia, muscle entrapment w/Graves ophthalmopathy, muscle entrapment in orbital fx
Can be due to peripheral motor disease: e.g. Guillain Barre
Autoimmune/Inflammatory: IgG4 related, Sarcoidosis, GPA, other
Symptoms
Resolves when one eye closed
Present when look in direction of impaired movement, resolves when look in directions of preserved movement
Physical Exam Findings
Exam to assess for level of dysfunction of CNs and/or extra-occular muscles that move eye→ loss of coordinated bilateral movement