Article Text

Download PDFPDF
Ocular Motor Palsy After Spinal Puncture
  1. Monica del-Rio–Vellosillo, MD, PhD*,
  2. José J. Garcia-Medina, MD, PhD,
  3. Maria Dolores Pinazo-Duran, MD, PhD,
  4. Antonio Abengochea-Cotaina, MD, PhD§ and
  5. Manuel Barbera-Alacreu, MD, PhD§
  1. *Department of Anesthesia, University Hospital Virgen de la Arrixaca
  2. Department of Ophthalmology and Optometry, University School of Medicine, Murcia
  3. Department of Ophthalmology, University School of Medicine, Valencia
  4. §Department of Anesthesia, University Hospital La Fe, Valencia, Spain
  1. correspondence: Monica del-Rio–Vellosillo University Hospital Virgen de la Arrixaca Ctra. Madrid-Cartagena, s/n 30120, El Palmar, Murcia, Spain (e-mail: monicadelriov{at}


Abstract Ocular motor palsy is a rare but alarming complication of subarachnoid puncture. In order to better understand this condition, a literature search was performed in English of PubMed articles for cranial nerves III, IV, and VI palsies after spinal puncture. Sixty-five articles (dated 1930–2015) were identified, and 114 cases were obtained for analysis. Subarachnoid anesthesia was the most frequent cause (45.6%), with a higher incidence for females than males. The age of patients was 40.24 ± 13.35 years (age range, 6–71 years). The sixth cranial nerve was the most commonly involved (92.1%), with higher frequency in the right eye. Palsy onset started 7.30 ± 4.09 days after puncture. Duration in reversible cases was 80.10 ± 80.67 days. Paresia was permanent in 13 patients, but only 2 patients required extraocular muscle surgery. Treatments included the horizontal position along with analgesics, fluid therapy, and corticosteroids. The usefulness of blood patch remains controversial. It is important for anesthesiologists and other physicians to recognize the cardinal features of this process to ensure early diagnosis, avoid unnecessary tests, and guide appropriate treatment.

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • The authors declare no conflict of interest.