2026 ICD-10-CM Diagnosis Code H49.9Unspecified paralytic strabismus

AHRQ’s CCSR groups this code into broader clinical categories.

• Horner Syndrome

  a syndrome associated with defective sympathetic innervation to one side of the face, including the eye. clinical features include miosis; mild blepharoptosis; and hemifacial anhidrosis (decreased sweating)(see hypohidrosis). lesions of the brain stem; cervical spinal cord; first thoracic nerve root; apex of the lung; carotid artery; cavernous sinus; and apex of the orbit may cause this condition. (from miller et al., clinical neuro-ophthalmology, 4th ed, pp500-11)

• Kearns-Sayre Syndrome

  a mitochondrial disorder featuring the triad of chronic progressive external ophthalmoplegia, cardiomyopathy (cardiomyopathies) with conduction block (heart block), and retinitis pigmentosa. disease onset is in the first or second decade. elevated csf protein, sensorineural deafness, seizures, and pyramidal signs may also be present. ragged-red fibers are found on muscle biopsy. (adams et al., principles of neurology, 6th ed, p984)

• Miller Fisher Syndrome

  a variant of the guillain-barre syndrome characterized by the acute onset of oculomotor dysfunction, ataxia, and loss of deep tendon reflexes with relative sparing of strength in the extremities and trunk. the ataxia is produced by peripheral sensory nerve dysfunction and not by cerebellar injury. facial weakness and sensory loss may also occur. the process is mediated by autoantibodies directed against a component of myelin found in peripheral nerves. (adams et al., principles of neurology, 6th ed, p1313; neurology 1987 sep;37(9):1493-8)

• Niemann-Pick Disease, Type A

  the classic infantile form of niemann-pick disease, caused by mutation in sphingomyelin phosphodiesterase. it is characterized by accumulation of sphingomyelins in the cells of the mononuclear phagocyte system and other cell throughout the body leading to cell death. clinical signs include jaundice, hepatosplenomegaly, and severe brain damage.

• Ocular Motility Disorders

  disorders that feature impairment of eye movements as a primary manifestation of disease. these conditions may be divided into infranuclear, nuclear, and supranuclear disorders. diseases of the eye muscles or oculomotor cranial nerves (iii, iv, and vi) are considered infranuclear. nuclear disorders are caused by disease of the oculomotor, trochlear, or abducens nuclei in the brain stem. supranuclear disorders are produced by dysfunction of higher order sensory and motor systems that control eye movements, including neural networks in the cerebral cortex; basal ganglia; cerebellum; and brain stem. ocular torticollis refers to a head tilt that is caused by an ocular misalignment. opsoclonus refers to rapid, conjugate oscillations of the eyes in multiple directions, which may occur as a parainfectious or paraneoplastic condition (e.g., opsoclonus-myoclonus syndrome). (adams et al., principles of neurology, 6th ed, p240)

• Ophthalmoplegia

  paralysis of one or more of the ocular muscles due to disorders of the eye muscles, neuromuscular junction, supporting soft tissue, tendons, or innervation to the muscles.

• Ophthalmoplegia, Chronic Progressive External

  a mitochondrial myopathy characterized by slowly progressive paralysis of the levator palpebrae, orbicularis oculi, and extraocular muscles. ragged-red fibers and atrophy are found on muscle biopsy. familial and sporadic forms may occur. disease onset is usually in the first or second decade of life, and the illness slowly progresses until usually all ocular motility is lost. (from adams et al., principles of neurology, 6th ed, p1422)

• Supranuclear Palsy, Progressive

  a degenerative disease of the central nervous system characterized by balance difficulties; ocular motility disorders (supranuclear ophthalmoplegia); dysarthria; swallowing difficulties; and axial dystonia. onset is usually in the fifth decade and disease progression occurs over several years. pathologic findings include neurofibrillary degeneration and neuronal loss in the dorsal mesencephalon; subthalamic nucleus; red nucleus; pallidum; dentate nucleus; and vestibular nuclei. (from adams et al., principles of neurology, 6th ed, pp1076-7)

• Guillain-Barre Syndrome

  an acute inflammatory autoimmune neuritis caused by t cell- mediated cellular immune response directed towards peripheral myelin. demyelination occurs in peripheral nerves and nerve roots. the process is often preceded by a viral or bacterial infection, surgery, immunization, lymphoma, or exposure to toxins. common clinical manifestations include progressive weakness, loss of sensation, and loss of deep tendon reflexes. weakness of respiratory muscles and autonomic dysfunction may occur. (from adams et al., principles of neurology, 6th ed, pp1312-1314)

• Twinkle mtDNA Helicase|Progressive External Ophthalmoplegia 1 Protein|T7 Gene 4-Like Protein with Intramitochondrial Nucleoid Localization|T7 Helicase-Related Protein with Intramitochondrial Nucleoid Localization|T7 gp4-Like Protein with Intramitochondrial Nucleoid Localization|T7-Like Mitochondrial DNA Helicase|TWNK|Twinkle Protein, Mitochondrial|p72

  twinkle mtdna helicase (684 aa, ~77 kda) is encoded by the human twnk gene. this protein plays a role in unwinding, replication and repair of mitochondrial dna.

• Minicore Myopathy with External Ophthalmoplegia

  an autosomal recessive condition caused by mutation(s) in the ryr1 gene, encoding ryanodine receptor 1. it may be characterized clinically by neonatal hypotonia, delayed motor development, and generalized muscle weakness, and amyotrophy. pathologically, the absence of mitochondria and focal disorganization of the sarcomere appear as "minicores" on atpase staining as a result of focal defects in oxidative activity.

• Ophthalmoplegia

  weakness or paralysis of at least one of the muscles controlling the movement of the eye. it results from degeneration of the muscles or the neural pathways involved in the eye movement. representative disorders causing ophthalmoplegia include ocular myopathies and multiple sclerosis.

• Progressive Supranuclear Palsy|Progressive supranuclear ophthalmoplegia|Steele-Richardson-Olszewski Syndrome

  a rare neurodegenerative disorder characterized by gait and balance difficulties and loss of coordination of eye movements.

Eye Movement Disorders

When you look at an object, you're using several muscles to move both eyes to focus on it. If you have a problem with the muscles, the eyes don't work properly.

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