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Infectious ocular motor neuropathies

Gluckstein, Jeffreya; Prasad, Sashankb

Current Opinion in Ophthalmology: November 2019 - Volume 30 - Issue 6 - p 454–461
doi: 10.1097/ICU.0000000000000615
NEURO-OPHTHALMOLOGY: Edited by Dean M. Cestari

Purpose of review Describe the range of infectious causes of ocular motor neuropathies, from common presentations to unusual manifestations of diseases less frequently seen in the developed world. Provide information on recent developments in diagnostic testing for pathogens that may cause ocular motor neuropathies.

Recent findings Antigen detection in serum or CSF has improved the diagnosis of cryptococcal disease. Cartridge PCR testing for tuberculosis has increased diagnostic accuracy, though tuberculous meningitis remains difficult to diagnose. Rapid, multiplex PCR and unbiased sequencing allow for diagnosis of a wider range of organisms.

Summary Infectious ocular motor neuropathies can occur anywhere along the length of cranial nerves III, IV, and VI. Characteristic clinical findings and imaging can be used to localize infections. Infectious causes may have characteristic clinical, laboratory, or imaging findings, but must still be carefully separated from inflammatory or neoplastic conditions.

aMassachusetts General Hospital, Department of Neurology

bBrigham and Women's Hospital, Department of Neurology, Boston, Massachusetts, USA

Correspondence to Jeffrey Gluckstein, MD, Brigham and Women's Hospital and Massachusetts General Hospital, Boston, MA 02115, USA. Tel: +1 909 957 5488; e-mail:

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