On Ophthalmoplegia Externa or Symmetrical Immobility (Partial) of the Eyes, with Ptosis

Abstract

THE cases to which I have to ask the attention of the Society are characterised by a very peculiar group of symptoms.Drooping of the eyelids, so as to give to the face a half-asleep expression, is usually the first, and it is soon accompanied by weakness of all the muscles attached to the eyeball, so that the movements of the latter become much restricted, or even wholly lost.The condition is usually bi- lateral, though it is not always exactly the same in degree on the two sides.Its symmetry probably denotes that it is of central origin.It by no means always happens that all the ocular muscles are alike affected, or that they are attacked simultaneously, still it is a very marked feature of the malady, that the muscles fail in groups, and not sin'gly.Non-symmetrical paralysis of single ocular muscles is, of 808 SYMMETRICAL IiNIMOBILITY (PARTIAL) OF THE EYES, course, very common, especially in connection with syphilis and locomotor ataxy, but such cases are to be distinguished from those which I am now describing: first, by the fact of non-symmetry: secondly, by the early completeness of the paralysis; and, thirdly, by the ease with which, very fre- quently, they are cured.In a majority of them, there is, perhaps, good reason to suspect that a gumma in the nerve trunk is the cause.In the symmetrical cases now under con- sideration, however, the changes probably begin centrally; they are usually slow in progress, and are often difficult of relief.They agree with the single nerve cases in that they occur chiefly to those who have had syphilis.Although I * The following particulars were kindly obtained for me by Dr. Sloman, of Farnbam."' About Christmas, 1874, loss of power in his arms was