Paralytic strabismus (H49)
Clinical Information
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)
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)
Instructional Notations
Type 2 Excludes
A type 2 excludes note represents "Not included here". An excludes2 note indicates that the condition excluded is not part of the condition represented by the code, but a patient may have both conditions at the same time. When an Excludes2 note appears under a code, it is acceptable to use both the code and the excluded code together, when appropriate.
- internal ophthalmoplegia H52.51
- internuclear ophthalmoplegia H51.2
- progressive supranuclear ophthalmoplegia G23.1
Diseases of the eye and adnexa (H00–H59)
Disorders of ocular muscles, binocular movement, accommodation and refraction (H49-H52)
H49 Paralytic strabismus
H49.0 Third [oculomotor] nerve palsy
- H49.00 Third [oculomotor] nerve palsy, unspecified eye
- H49.01 Third [oculomotor] nerve palsy, right eye
- H49.02 Third [oculomotor] nerve palsy, left eye
- H49.03 Third [oculomotor] nerve palsy, bilateral
H49.1 Fourth [trochlear] nerve palsy
- H49.10 Fourth [trochlear] nerve palsy, unspecified eye
- H49.11 Fourth [trochlear] nerve palsy, right eye
- H49.12 Fourth [trochlear] nerve palsy, left eye
- H49.13 Fourth [trochlear] nerve palsy, bilateral
H49.2 Sixth [abducent] nerve palsy
- H49.20 Sixth [abducent] nerve palsy, unspecified eye
- H49.21 Sixth [abducent] nerve palsy, right eye
- H49.22 Sixth [abducent] nerve palsy, left eye
- H49.23 Sixth [abducent] nerve palsy, bilateral
H49.3 Total (external) ophthalmoplegia
- H49.30 Total (external) ophthalmoplegia, unspecified eye
- H49.31 Total (external) ophthalmoplegia, right eye
- H49.32 Total (external) ophthalmoplegia, left eye
- H49.33 Total (external) ophthalmoplegia, bilateral
H49.4 Progressive external ophthalmoplegia
- H49.40 Progressive external ophthalmoplegia, unspecified eye
- H49.41 Progressive external ophthalmoplegia, right eye
- H49.42 Progressive external ophthalmoplegia, left eye
- H49.43 Progressive external ophthalmoplegia, bilateral
H49.8 Other paralytic strabismus
H49.81 Kearns-Sayre syndrome
- H49.811 Kearns-Sayre syndrome, right eye
- H49.812 Kearns-Sayre syndrome, left eye
- H49.813 Kearns-Sayre syndrome, bilateral
- H49.819 Kearns-Sayre syndrome, unspecified eye
H49.88 Other paralytic strabismus
- H49.881 Other paralytic strabismus, right eye
- H49.882 Other paralytic strabismus, left eye
- H49.883 Other paralytic strabismus, bilateral
- H49.889 Other paralytic strabismus, unspecified eye
- H49.9 Unspecified paralytic strabismus
Paralytic strabismus (H49)