[A drug induced deviation of the eyes: the oculogyric crisis]

Ned Tijdschr Geneeskd. 2021 Nov 30:165:D5988.
[Article in Dutch]

Abstract

An oculogyric crisis is a tonic conjugated deviation of the eyes, usually upward. We present two cases with a drug induced oculogyric crisis. The differential diagnoses should include epilepsy, a functional neurological movement disorder, ocular tics, ocular dyskinesia or ocular bobbing. Typically, in an oculogyric crisis the patient's awareness is intact; accompanied signs can be blepharospasm, neck flexion, jaw opening with or without tongue protrusion and autonomic symptoms. The underlying pathophysiology seems an imbalance between cholinergic and dopaminergic pathways. Most frequently an oculogyric crisis is caused by antidopaminergic medications, for example neuroleptics and metoclopramide. Treatment of medication-induced oculogyric crisis with parenteral anticholinergics typically leads to a fast remission of symptoms. Consider tocontinue anticholinergic therapy orally for a few days.

MeSH terms

  • Antipsychotic Agents* / adverse effects
  • Cholinergic Antagonists / adverse effects
  • Dystonia* / chemically induced
  • Dystonia* / diagnosis
  • Eye Diseases*
  • Humans
  • Ocular Motility Disorders* / chemically induced
  • Ocular Motility Disorders* / diagnosis

Substances

  • Antipsychotic Agents
  • Cholinergic Antagonists