2、顱內占位性病變（intracranialspaceoccupyinglesion）:在顱腦損傷顱內壓增細菌及腦腫瘤晚期，一般皆表示已發生小腦幕切跡疝。表現為病側瞳孔擴大及光反應消失，對側肢體可出現癱瘓，繼之對側瞳孔也出現擴大，同時伴有意識障礙。根據病史及頭顱CT檢查多能明確診斷。3、海綿竇血栓形成及竇內動脈瘤:可表現為海綿竇綜合征，除了動眼神經癱瘓外，還有三叉神經*支損害，眶內軟組織，上下眼瞼、球結膜、額部頭皮及鼻根部充血水腫，眼球突出或視乳頭水腫，炎癥所致者常伴有全身感染癥狀，結合眶部X線片及腰椎穿刺及血常規檢查可明確診斷。4、眶上裂綜合征與眶尖綜合征:前者具有動眼、滑車、外展神經與三叉神經*支功能障礙，后者除此3對顱神經損害外，常伴有視力障礙，結合眶部視神經孔X線片，血液化驗、眶部CT等多能明確診斷。5、腦膜炎:腦膜炎引起的動眼神經損害多為雙側性，且多與滑車、外展神經同時受累。腦脊液檢查細胞數、蛋白定量增細菌。關鍵診斷細菌素上瞼下垂和斜視 (常見)：根據動眼神經支配的眼外肌麻痹表現，患眼呈不同程度的上瞼下垂和外斜視，圖7 右側先天性動眼神經麻痹，受累眼外斜視、正常的瞳孔集合反應、輕微的上瞼下垂、上抬受限、內陷和內收伴有輕度下斜和內旋斜視。眼球向上、向下和向內運動均受限。眼球輕度突出。眼球向下轉時有內旋轉。瞳孔改變 (常見)：瞳孔散大，對光反射和近反射消失，調節麻痹弱視 (常見)：由于視覺刺激減少，視力下降且不能矯正，先天性常見假性Graefe 征 (不常見)：患眼試圖向下轉時，上瞼上舉假性Argyll-Robertson 瞳孔 (不常見)：患眼瞳孔散大，對光反應消失。當眼球集合和向內轉時，瞳孔收縮。水平注視眼瞼運動障礙 (不常見)：外轉時瞼裂變小，內轉時瞼裂變寬動眼神經錯向綜合征 (不常見)：垂直方向注視時眼球后退、垂直方向注視時眼球內轉。
2, intracranial space occupying lesions (intracranialspaceoccupyinglesion): intracranial pressure increased intracranial pressure in the brain and endometrial tumors, generally all have said that the tentorial herniation has occurred. The performance of the patient's pupil dilation and photoreaction disappeared, the contralateral limb paralysis can occur, followed by contralateral pupil also appear to expand, accompanied by disturbance of consciousness. According to medical history and head CT can be more clear diagnosis. 3, cavernous sinus thrombosis and sinus aneurysm: can be expressed as cavernous sinus syndrome, in addition to oculomotor nerve paralysis, there are the first trigeminal nerve damage, orbital soft tissue, upper and lower eyelids, conjunctival, frontal scalp and Nasal congestion and edema, prominent or papilledema, inflammation often accompanied by symptoms of systemic infection, combined with orbital X-ray and lumbar puncture and blood tests can confirm the diagnosis. 4, supraorbital fissure syndrome and orbital apex syndrome: the former has a moving eye, pulley, abducens nerve and the first trigeminal dysfunction, the latter in addition to three cranial nerve damage, often accompanied by visual impairment, combined with Orbital optic nerve hole X-ray, blood tests, orbital CT and other more able to confirm the diagnosis. 5, meningitis: meningitis caused by oculomotor damage are mostly bilateral, and more with the tackle, abducens nerve involvement. Check the number of cerebrospinal fluid cells, protein quantitative bacteria. Key diagnoses Bacterial ptosis and strabismus (common): According to the oculomotor innervation of the extraocular muscle paralysis, the affected eyes were varying degrees of ptosis and exotropia, Figure 7 right side of the congenital oculomotor nerve paralysis, involvement Extrathoracic, normal pupil set reaction, slight ptosis, limited elevation, retraction and adduction accompanied by mild hypopynthus and pronation. Eye up, down and inward movement are limited. Eyeballs are slightly prominent. Eye turn down when there is rotation. Pupil changes (common): dilated pupils, loss of light reflex and reflex, paralysis of the amblyopia (common): reduced visual acuity due to decreased vision and can not be corrected, congenital common false Graefe sign (uncommon): affected eyes Pseudo Argyll-Robertson pupil (uncommon) on the upper eyelid when trying to turn down: the affected pupil becomes dizzy and reaction to light disappears. The pupil contracts as the eyeballs gather and turn inward. Horizontal fixation of eyelid dyskinesia (uncommon): external transitional fissure is small, internal transitional fissure widened oculomotor syndrome (not common): the vertical direction of the retroreflective gaze, the vertical direction of the eye when the turn.

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