Introduction
Oculogyric crises are the spasms (contractions) of the muscles responsible for eye movements. These spasms lead to a change in the position of the eyeball, and it deviates in the upward direction. This condition was earlier seen in patients suffering from encephalitis (infection and inflammation of the brain). Still, it is commonly seen in patients on medications for psychiatric disorders (mental illness).
What Are Oculogyric Crises?
Oculogyric crises are dystonia (abnormal contraction) of the ocular muscles (eye muscles). In this disorder, the eyeball is deviated upwards and gets fixed in that position. This condition is associated with mental disturbances such as anxiety and restlessness. It can cause the patient to stare blankly in one direction, followed by eyeball deviation. An attack of oculogyric crises may occur suddenly. Stress or emotional disturbances are triggering factors for this condition. A single episode of an oculogyric crisis can last from a few hours to days or weeks. These abnormal movements of the eyeball are also accompanied by pain.
What Causes Oculogyric Crises?
Oculogyric crises may be caused due to the following reasons -
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Medications - Oculogyric crises can be triggered by medications used to treat psychiatric problems. Symptoms of oculogyric crises occur as a side effect of these medications. They block the conduction of impulses between neurons by inhibiting the action of the neurotransmitter acetylcholine. Dopamine is also a neurotransmitter that conducts the impulses in the neurons. Antidepressants and antipsychotic medications block the action of dopamine, thereby causing abnormal neurological symptoms. Imbalances in dopamine levels cause neurological symptoms. Medications that help in treating nausea and vomiting, known as antiemetics, also trigger this condition.
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Neurodegenerative Disorders - Neurological disorders affect dopamine transmission in the brain and cause low dopamine levels. Hypodopaminergic condition of the brain is often associated with oculogyric crises.
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Focal Lesions of the Brain - Focal lesions present in the brainstem, midbrain, and basal ganglia.
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Infections - Brain infections such as encephalitis may cause symptoms of oculogyric crises.
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External Factors - Physical fatigue and emotional stress also trigger this condition.
Which Diseases Are Associated With Oculogyric Crises?
Oculogyric crises can occur as a result of rare neurodegenerative disorders such as -
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Neuronal Intranuclear Inclusion Disorder - This is a slowly progressing neurodegenerative disorder. It can affect any part of the nervous system. This disorder is characterized by problems with balance and coordination.
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Kufor Rakeb Disease - It is a rare, inherited neurodegenerative disorder characterized by parkinsonism symptoms such as tremors, rigidity, and difficulty with movement.
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Perry Syndrome - It is an extremely rare inherited neurological disorder that causes movement abnormalities, cognitive decline, and psychiatric symptoms.
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Rett Syndrome - It is a neurodevelopmental disorder that predominantly affects females. It is characterized by a loss of purposeful hand skills, slowed growth, intellectual disability, and impaired social and communication abilities.
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Chediak Higashi Syndrome - It is a rare genetic disorder characterized by a variety of symptoms, including partial albinism (light-colored hair and skin), recurrent infections, and neurological abnormalities.
What Are the Risk Factors of Oculogyric Crises?
The following may be risk factors for this condition -
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Children and young adults are more vulnerable to this disease.
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This disease is common in males.
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Individuals with existing infections such as encephalitis.
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Patients are being treated with high doses of antipsychotic medications.
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Individuals with coexisting systemic diseases.
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Patients with a family history of dystonia.
What Are the Signs and Symptoms of Oculogyric Crises?
The attacks of oculogyric crises may appear abruptly. They may last for a few seconds or persist together for days. The patient experiences the following symptoms -
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The patient might feel uneasy and start sweating before an attack.
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Deviation (change in the position) of the eyeball and fixation, usually in an upward direction, followed by pain in the eye. The patient may continuously keep blinking their eyes.
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Flexion of the neck is also known as neck dystonia (involuntary contraction of the neck muscles).
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Blepharospasm (when both the eyelids close involuntarily or there is an inability to keep the eyelids open) may also be seen.
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Abnormal jaw movements may cause tooth fractures and a protruding tongue, leading to increased drooling.
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There may be an increase in the heart rate and blood pressure of the patient.
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The pupils may get dilated.
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The patient may experience a severe headache and exhaustion post an attack of oculogyric crises.
How Is This Condition Diagnosed?
The diagnosis of oculogyric crises depends mainly on the clinical symptoms.
The physician obtains a detailed medical history of the patient regarding systemic diseases and the drugs used. All the signs and symptoms experienced by the patient are noted carefully. The following criteria have to be met to confirm the diagnosis -
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A period of restlessness and anxiety with increased sweating followed by the deviation of the eyeball and its fixation in an upward direction.
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The attack lasts for a few minutes to hours.
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The patient is fully conscious and aware of the symptoms that are occurring.
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The condition of the patient improves after the administration of drugs that increase dopamine levels.
If the criteria mentioned above are met, the diagnosis is confirmed for oculogyric crises.
How Are Oculogyric Crises Treated?
The treatment of oculogyric crises is the withdrawal of the triggering factors of the symptoms.
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Antipsychotic medications are responsible for the occurrence of the attacks. Complete withdrawal of these medications will lead to an improvement in symptoms. But there are certain cases where the medication cannot be stopped because that would be life-threatening to the patient. The dosage of the antipsychotic medication is altered. Low-dose medicines are administered to reduce the intensity and frequency of the attacks.
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Dopaminergic drugs administered intravenously (drugs that help increase dopamine levels) are also beneficial in treating these attacks.
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Plenty of sleep and rest is advised to the patient to overcome the fatigue caused by these attacks.
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Treatment of coexisting mental problems such as anxiety and depression as they are triggering factors of this condition.
Conclusion
Oculogyric crisis is a serious condition, and it needs immediate medical care. Early diagnosis and detection of symptoms are critical in treating this disorder. Withdrawal or reduction in the dosage of antipsychotic and antiemetic medications proves to help manage this condition. This disease may also occur in patients suffering from other neurological disorders. Patients with a family history of dystonia are more prone to developing this condition. However, this condition is treatable, and the prognosis is good. Medications that help increase dopamine levels are beneficial in improving the symptoms.
