Oculomotor nerve palsy is a nerve condition that affects your vision. It can lead to double vision and difficulties using both eyes together. A weakness in the oculomotor nerves causes this condition, resulting in a loss of control over important eye muscles.

Sometimes, people are born with oculomotor nerve motor palsy. In other cases, the condition results from illness or injury. Treatment depends on the underlying cause but might include surgery, corrective lenses, or vision therapy.

Oculomotor nerve palsy is any decreased strength of the oculomotor nerves. These nerves coordinate vital muscle movements of your eyes. They help your eyes focus and are responsible for defining your visual field. Eye muscles controlled by the oculomotor nerves include the:

  • superior rectus
  • inferior rectus
  • medial rectus
  • inferior oblique
  • levator palpebrae superioris

Oculomotor palsy can affect one or all of these muscles. It can be partial with mild symptoms, or full with severe symptoms.

There are multiple causes of oculomotor nerve palsy. In many cases, the condition is developmental and sometimes present at birth. It can also occur as a result of injury during the birthing process.

When people acquire oculomotor nerve palsy later in life, it can result from many conditions, infections, and injuries. They include:

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Medical Illustration by Bailey Mariner

The symptoms of oculomotor nerve palsy can depend on the severity and the number of muscles affected. Most symptoms are also symptoms of other eye health or nerve conditions.

However, it’s always a good idea to contact a medical professional about any symptoms that affect your vision. Many conditions that change your vision can worsen, and early treatment can be important.

Common symptoms of ocular nerve palsy include:

  • Double vision. Oculomotor nerve palsy affects how your eyes work together. When your eyes can’t work together correctly, it can cause double vision.
  • Loss of eye focus and crossed eyes. It can be difficult to focus your eyes or control the direction of your eye movement when you have oculomotor nerve palsy. Often, people with this condition have difficulty moving their eyes in the same direction at the same time.
  • Atypical head motions. People with oculomotor nerve palsy often move their heads to compensate for their weakened eye muscles. This can lead to head motions and positions that can distract you or feel uncomfortable.

What does oculomotor nerve palsy look like?

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Medical Illustration by Bailey Mariner

Treatment for oculomotor nerve palsy will depend on the underlying cause and severity. You might need to have a range of testing before your doctors can finalize a treatment plan. Testing will help doctors find the exact cause and muscles involved.

Common treatment options include:

  • Surgery to relieve pressure on the nerve. Doctors often perform surgery in the case of a tumor, aneurysm, or noncancerous growth.
  • Eye muscle surgery. A type of eye surgery called strabismus surgery can help realign the eyes.
  • Temporary eye patches or prism glasses. These visual aids can help manage double vision. You might wear these for 6 months to a year. Sometimes, this is enough for the oculomotor nerve palsy to heal on its own.
  • Permanent prism glasses. You can wear prism glasses daily to manage double vision.
  • Vision therapy. Vision therapy is a program that helps strengthen eye muscles to help reduce or eliminate symptoms.

How long does recovery from oculomotor nerve palsy take?

Since there are so many causes for oculomotor nerve palsy, it’s difficult to say how long recovery will take. Many people do make a full recovery from this condition after a few months, but your progress will depend on the severity and any underlying conditions.

For example, healing might be more difficult for someone with a condition such as diabetes, as they might need to manage that condition before their oculomotor nerve palsy resolves. Conversely, someone recovering from an injury might recover after 1 or 2 months of vision therapy.

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Your coverage will depend on the specific treatment. Medicare or other insurance plans do not generally include coverage for visual problems. It’s rare for treatments such as eye patches, glasses, specialty lenses, or vision therapy to be covered.

However, treatment options, such as surgery to relieve pressure on the ocular nerve, might be covered by some plans. For example, although Medicare doesn’t cover treatments such as vision therapy and prism lens, it does cover surgical procedures that repair eye function.

It’s a good idea to talk with your doctors about any planned treatments ahead of time. You can then call your insurance company to see what coverage they offer.

In many cases, oculomotor nerve palsy resolves within a few months. When it doesn’t, options such as glasses with prism lenses can help you manage the symptoms in your everyday life. Surgical treatments and vision therapy can also reduce symptoms and help improve eye muscle strength.

The underlying cause of your oculomotor nerve palsy affects your range of treatment options and your outlook. In the case of some causes, such as high blood pressure or diabetes, managing those causes can be a big part of improving your outlook.

Getting help

Managing a diagnosis like oculomotor nerve palsy can be overwhelming and stressful. Online mental health resources are great ways to get support throughout your treatment.

Some places to start include:

  • Talkspace. Talkspace is a therapy and psychiatry platform that allows you to meet with your therapist through text, phone, and video chat. It can be a good fit for people seeking mental health support from home.
  • Support Group Central. If you’d like to talk with peers, Support Group Central is a great place to look. You can search for online groups of people managing health conditions. You can even narrow your search to people in your local area, or to people you have additional things in common with.
  • 7-cups. You can talk with trained peer counselors or use the community live chat with 7-cups, a mental health resource designed for anyone who needs support.
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Oculomotor nerve palsy is a condition that affects the oculomotor nerves of your eyes. It causes decreased strength and a harder time controlling your eye muscles. This leads to double vision and difficulty focusing your eyes.

Oculomotor nerve palsy can be present at birth or can result from health conditions, injuries, or infections. In some cases, oculomotor nerve palsy resolves quickly without intervention. When you need treatment, a combination of surgery, corrective vision aids, and vision therapy might help.