Internal ophthalmoplegia is characterized by paresis of ciliary body with loss of power of accommodation and pupil dilatation because of lesions of ciliary ganglion.
1. Acute porphyria-frequently bilateral
*2. Adie syndrome (myotonic pupil)
3. Aneurysm of the posterior communicating artery at its junction with the internal carotid-unilateral
*5. Cycloplegic ocular medication-most common
6. During acute illness-transient
7. During blepharoplasty-transient
8. Fisher syndrome (ophthalmoplegia-ataxia-areflexia syndrome)
9. Foramen lacerum syndrome (aneurysm of internal carotid artery)
10. Histiocytosis X (Hand-Schüller-Christian syndrome)
11. Hollenhorst syndrome (chorioretinal infarction syndrome)
*12. Increased intracranial pressure
13. Infections, including chickenpox, measles, diphtheria, syphilis, scarlet fever, pertussis, smallpox, influenza, herpes zoster, botulism, sinusitis, and viral hepatitis
14. Lubarsch-Pick syndrome (amyloidosis)
15. May be early lesion of acute or chronic ophthalmoplegia
16. Metastatic tumors of choroid
17. Nasopharyngeal carcinoma-early
18. Nothnagel syndrome (ophthalmoplegia-cerebellar ataxia syndrome)
19. Partial seizures
20. Retrobulbar injections of alcohol
21. Transscleral diathermy
22. Trauma to eye or orbit
23. Vogt-Koyanagi-Harada syndrome (uveitis-vitiligo-alopecia-poliosis syndrome)
Perlman JP, Conn H. Transient internal ophthalmoplegia during blepharoplasty: a report of three cases. Ophthal Plast Reconstr Surg 1991;7:141-143.
Rosenberg ML, Jabbari B. Miosis and internal ophthalmoplegia as a manifestation of partial seizures. Neurology 1991; 41:737-739.
Roy FH. Ocular syndromes and systemic diseases, 3rd ed. Philadelphia: Lippincott Williams & Wilkins, 2002.