Clinical-Radiologic Correlation of Extraocular Eye Movement Disorders: Seeing beneath the Surface.
Extraocular eye movement disorders are relatively common and may be a significant source of discomfort and morbidity for patients. The presence of restricted eye movement can be detected clinically with quick, easily performed, noninvasive maneuvers that assess medial, lateral, upward, and downward gaze. However, detecting the presence of ocular dysmotility may not be sufficient to pinpoint the exact cause of eye restriction. Imaging plays an important role in excluding, in some cases, and detecting, in others, a specific cause responsible for the clinical presentation. However, the radiologist should be aware that the imaging findings in many of these conditions when taken in isolation from the clinical history and symptoms are often nonspecific. Normal eye movements are directly controlled by the ocular motor cranial nerves (CN III, IV, and VI) in coordination with indirect input or sensory stimuli derived from other cranial nerves. Specific causes of ocular dysmotility can be localized to the cranial nerve nuclei in the brainstem, the cranial nerve pathways in the peripheral nervous system, and the extraocular muscles in the orbit, with disease at any of these sites manifesting clinically as an eye movement disorder. A thorough understanding of central nervous system anatomy, cranial nerve pathways, and orbital anatomy, as well as familiarity with patterns of eye movement restriction, are necessary for accurate detection of radiologic abnormalities that support a diagnostic source of the suspected extraocular movement disorder.©RSNA, 2016.
From the Departments of Radiology (J.T., Y.M.C., M.N.C., K.H., A.F., O.S.), Ophthalmology (R.S.), Otolaryngology-Head and Neck Surgery (O.S.), and Radiation Oncology (O.S.), Boston Medical Center, Boston University School of Medicine, 820 Harrison Ave, 3rd Floor, Boston, MA 02118; Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (Y.M.C.); Department of Radiology, Veterans Administration Boston Healthcare System, Boston, Mass (M.N.C.); and Department of Radiology, Jichi Medical University School of Medicine, Shimotsuke, Tochigi, Japan (A.F.).
Joshua
J
Thatcher
From the Departments of Radiology (J.T., Y.M.C., M.N.C., K.H., A.F., O.S.), Ophthalmology (R.S.), Otolaryngology-Head and Neck Surgery (O.S.), and Radiation Oncology (O.S.), Boston Medical Center, Boston University School of Medicine, 820 Harrison Ave, 3rd Floor, Boston, MA 02118; Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (Y.M.C.); Department of Radiology, Veterans Administration Boston Healthcare System, Boston, Mass (M.N.C.); and Department of Radiology, Jichi Medical University School of Medicine, Shimotsuke, Tochigi, Japan (A.F.).
Yu-Ming
YM
Chang
From the Departments of Radiology (J.T., Y.M.C., M.N.C., K.H., A.F., O.S.), Ophthalmology (R.S.), Otolaryngology-Head and Neck Surgery (O.S.), and Radiation Oncology (O.S.), Boston Medical Center, Boston University School of Medicine, 820 Harrison Ave, 3rd Floor, Boston, MA 02118; Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (Y.M.C.); Department of Radiology, Veterans Administration Boston Healthcare System, Boston, Mass (M.N.C.); and Department of Radiology, Jichi Medical University School of Medicine, Shimotsuke, Tochigi, Japan (A.F.).
Margaret N
MN
Chapman
From the Departments of Radiology (J.T., Y.M.C., M.N.C., K.H., A.F., O.S.), Ophthalmology (R.S.), Otolaryngology-Head and Neck Surgery (O.S.), and Radiation Oncology (O.S.), Boston Medical Center, Boston University School of Medicine, 820 Harrison Ave, 3rd Floor, Boston, MA 02118; Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (Y.M.C.); Department of Radiology, Veterans Administration Boston Healthcare System, Boston, Mass (M.N.C.); and Department of Radiology, Jichi Medical University School of Medicine, Shimotsuke, Tochigi, Japan (A.F.).
Keegan
K
Hovis
From the Departments of Radiology (J.T., Y.M.C., M.N.C., K.H., A.F., O.S.), Ophthalmology (R.S.), Otolaryngology-Head and Neck Surgery (O.S.), and Radiation Oncology (O.S.), Boston Medical Center, Boston University School of Medicine, 820 Harrison Ave, 3rd Floor, Boston, MA 02118; Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (Y.M.C.); Department of Radiology, Veterans Administration Boston Healthcare System, Boston, Mass (M.N.C.); and Department of Radiology, Jichi Medical University School of Medicine, Shimotsuke, Tochigi, Japan (A.F.).
Akifumi
A
Fujita
From the Departments of Radiology (J.T., Y.M.C., M.N.C., K.H., A.F., O.S.), Ophthalmology (R.S.), Otolaryngology-Head and Neck Surgery (O.S.), and Radiation Oncology (O.S.), Boston Medical Center, Boston University School of Medicine, 820 Harrison Ave, 3rd Floor, Boston, MA 02118; Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (Y.M.C.); Department of Radiology, Veterans Administration Boston Healthcare System, Boston, Mass (M.N.C.); and Department of Radiology, Jichi Medical University School of Medicine, Shimotsuke, Tochigi, Japan (A.F.).
Rachel
R
Sobel
From the Departments of Radiology (J.T., Y.M.C., M.N.C., K.H., A.F., O.S.), Ophthalmology (R.S.), Otolaryngology-Head and Neck Surgery (O.S.), and Radiation Oncology (O.S.), Boston Medical Center, Boston University School of Medicine, 820 Harrison Ave, 3rd Floor, Boston, MA 02118; Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (Y.M.C.); Department of Radiology, Veterans Administration Boston Healthcare System, Boston, Mass (M.N.C.); and Department of Radiology, Jichi Medical University School of Medicine, Shimotsuke, Tochigi, Japan (A.F.).
Osamu
http://orcid.org/0000-0003-3462-5116
O
Sakai
D003389:Cranial Nerve Diseases / Q000000981:diagnostic imaging*; D003937:Diagnosis, Differential; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D015835:Ocular Motility Disorders / Q000000981:diagnostic imaging*; D009801:Oculomotor Muscles / Q000000981:diagnostic imaging*; D015840:Oculomotor Nerve Diseases / Q000000981:diagnostic imaging*; D013223:Statistics as Topic; D014057:Tomography, X-Ray Computed / Q000379:methods*