Clinical Diagnosis and Management of Oculogyric Crisis: A Narrative Review
Literature Review
DOI:
https://doi.org/10.55175/cdk.v53i10.2044Keywords:
Dystonic reaction, extraocular muscles, neurology, oculogyric crisis, psychiatryAbstract
Oculogyric crisis (OGC) is an acute dystonic reaction characterized by sustained, involuntary upward deviation of the eyes caused by repetitive spasms of the extraocular muscles. Episodes may last from several seconds to several hours. OGC is often misdiagnosed, particularly outside neurology and psychiatry, partly because of its variable presentation and its resemblance to other neurological or psychogenic movement disorders. Its pathophysiological mechanisms are not yet fully understood, although disruption of dopaminergic neurotransmission is a consistent finding. OGC is most frequently associated with the use of medications that affect dopaminergic pathways, including antipsychotics and certain antiemetics; it may also co-occur with underlying neurological or psychiatric conditions. Effective management typically involves withdrawing the causative agent and administering anticholinergic medications. This narrative review summarizes the etiology, pathophysiology, clinical manifestations, differential diagnosis, and management of OGC, providing a practical clinical overview for general practitioners and relevant specialists. Greater awareness of OGC may facilitate timely recognition and appropriate management while reducing diagnostic delays and unnecessary investigations.
Downloads
References
Mahal P, Suthar N, Nebhinani N. Spotlight on oculogyric crisis: a review. Indian J Psychol Med. 2021;43(1):5–9. doi:10.1177/0253717620942096.
Mandani YR, Saputra GN. Gangguan gerak pada stroke. Cermin Dunia Kedokt. 2023;50(7):360–4. https://doi.org/10.55175/cdk.v50i7.642.
Wu L, Lv T. A brief review on clinical treatment of oculogyric crisis. J Neurol Neuromed. 2024;8(3):1–4. doi: 10.29245/2572.942X/2024/3.1304.
Barow E, Schneider SA, Bhatia KP, Ganos C. Oculogyric crises: etiology, pathophysiology and therapeutic approaches. Parkinsonism Relat Disord. 2017;36:3–9. doi: 10.1016/j.parkreldis.2016.11.012.
Lewis K, O’Day CS. Dystonic reactions [Internet]. Treasure Island (FL): StatPearls Publ.; 2025. Available from: https://www.ncbi.nlm.nih.gov/books/NBK531466/. PMID: 30285361.
Boi S, Garcia-Malo C, Rodríguez CI. Oculogyric crisis: a rare type of dystonia. J Psychiatry Neurosci. 2021;46(4):E429–30. doi: 10.1503/jpn.210026.
Morton A, Mackle C, Pavey J. Akathisia and oculogyric crisis in hyperemesis gravidarum. Obstet Med. 2024;17(2):129–31. doi: 10.1177/1753495X221137942.
Gardner DM, Abidi S, Ursuliak Z, Morrison J, Teehan MD, Tibbo PG. Incidence of oculogyric crisis and long-term outcomes with second-generation antipsychotics in a first-episode psychosis program. J Clin Psychopharmacol. 2015;35(6):715–8. doi: 10.1097/JCP.0000000000000411.
Sauerbier A, Gronostay A, Dafsari HS. SOP: acute hyperkinetic movement disorders. Neurol Res Pract. 2023;5(1):35. doi: 10.1186/s42466-023-00260-w.
Avanzino L, Abbruzzese G. How does the cerebellum contribute to the pathophysiology of dystonia? Basal Ganglia. 2012;2(4):231–5. doi:10.1016/j.baga.2012.05.003.
Bologna M, Berardelli A. The cerebellum and dystonia. Handbook of Clinical Neurology. 2018;155:259–72. doi:10.1016/b978-0-444-64189-2.00017-2.
Al-Fatly B, Neudorfer C, Kaski D, Lang AE, Kühn AA, Fox MD, et al. Lesion network of oculogyric crises maps to brain dopaminergic transcriptomic signature. Brain. 2024 Jun 3;147(6):1975–81. doi: 10.1093/brain/awae094.
Azami H, Chang Z, Arnold SE, Sapiro G, Gupta AS. Detection of oculomotor dysmetria from mobile phone video of the horizontal saccades task using signal processing and machine learning approaches. IEEE Access. 2022;10:34022–31. doi: 10.1109/access.2022.3156964.
Slow EJ, Lang AE. Oculogyric crises: a review of phenomenology, etiology, pathogenesis, and treatment. Mov Disord. 2017;32(2):193–202. doi: 10.1002/mds.26910.
Yildiz Y, Pektas E, Tokatli A, Haliloglu G. Hereditary dopamine transporter deficiency syndrome: challenges in diagnosis and treatment. Neuropediatrics. 2017;48(1):49–52. doi: 10.1055/s-0036-1593372.
Portaro S, Gugliandolo A, Scionti D, Cammaroto S, Morabito R, Leonardi S, et al. When dysphoria is not a primary mental state. Medicine (Baltimore). 2018;97(22):e10953. doi: 10.1097/md.0000000000010953.
Wassenberg T, Molero-Luis M, Jeltsch K, Hoffmann GF, Assmann B, Blau N, et al. Consensus guideline for the diagnosis and treatment of aromatic l-amino acid decarboxylase (AADC) deficiency. Orphanet J Rare Dis. 2017;12(1):12. doi: 10.1186/s13023-016-0522-z.
De Giorgis V, Varesio C, Baldassari C, Piazza E, Olivotto S, Macasaet J, et al. Atypical manifestations in glut1 deficiency syndrome. J Child Neurol. 2016;31(9):1174–80. doi: 10.1177/0883073816650033.
Jacobsen JC, Wilson C, Cunningham V, Glamuzina E, Prosser DO, Love DR, et al. Brain dopamine-serotonin vesicular transport disease presenting as a severe infantile hypotonic parkinsonian disorder. J Inherit Metab Dis. 2016;39(2):305–8. doi: 10.1007/s10545-015-9897-6.
Almannai M, Felemban R, Saleh MA, Faqeih EA, Alasmari A, AlHashem A, et al. 6-Pyruvoyltetrahydropterin synthase deficiency: review and report of 28 Arab subjects. Pediatr Neurol. 2019;96:40–7. doi: 10.1016/j.pediatrneurol.2019.02.008.
Rohani M, Shahidi G, Vali F, Lang AE, Slow E, Gahl WA, et al. Oculogyric crises in PLA2G6 associated neurodegeneration. Parkinsonism Relat Disord. 2018;52:111–2. doi: 10.1016/j.parkreldis.2018.03.010.
Zupanc ML, Chun RW, Gilbert-Barness EF. Osmiophilic deposits in cytosomes in hallervorden-spatz syndrome. Pediatr Neurol. 1990;6(5):349–52. doi: 10.1016/0887-8994(90)90030-5.
Kamida T, Maruyama T, Fujiki M, Kobayashi H, Izumi T, Baba H. Total callosotomy for a case of lissencephaly presenting with West syndrome and generalized seizures. Childs Nerv Syst. 2005;21(12):1056–60. doi: 10.1007/s00381-004-1081-5.
Kis B, Hedrich K, Kann M, Schwinger E, Kompf D, Klein C et al. Oculogyric dystonic states in early-onset parkinsonism with basal ganglia calcifications. Neurology. 2005;65(5):761. doi: 10.1212/01.wnl.0000180349.84136.e1.
Divac N, Prostran M, Jakovcevski I, Cerovac N. Second-generation antipsychotics and extrapyramidal adverse effects. Biomed Res Int. 2014;2014:656370. doi: 10.1155/2014/656370.
Nebhinani N, Suthar N. Oculogyric crisis with atypical antipsychotics: a case series. Indian J Psychiatry. 2017;59(4):499–501. doi: 10.4103/psychiatry.IndianJPsychiatry_211_17.
Das S, Agrawal A. Lurasidone-induced oculogyric crisis. Indian J Psychol Med. 2017;39(5):719–20. doi: 10.4103/IJPSYM.IJPSYM_266_17.
Lv T, Wu L, Li L, Zhang M, Tan Q, Liu P. Oculogyric crisis symptoms related to risperidone treatment: a case report. BMC Psychiatry. 2023;23(1):875. doi: 10.1186/s12888-023-05379-3.
Sonne J, Reddy V, Beato MR. Neuroanatomy, substantia nigra [Internet]. Treasure Island: StatPearls Publishing; 2024. Available from: https://pubmed.ncbi.nlm.nih.gov/30725680/. PMID: 30725680.
Jacob S, Ly H, Villenueva RJ, Gupta HV. Acute dystonic reaction in a patient with parkinson’s disease after diphenhydramine withdrawal. Acta Neurol Belg. 2017;117(1):345–6. doi: 10.1007/s13760-016-0626-1.
Schneider SA, Udani V, Sankhla CS, Bhatia KP. Recurrent acute dystonic reaction and oculogyric crisis despite withdrawal of dopamine receptor blocking drugs. Mov Disord. 2009;24(8):1226–9. doi: 10.1002/mds.22532.
Conway J, Seay MD, Rucker JC. Neuro-ophthalmologic emergencies in movement disorders. In: Frucht SJ, editor. Movement disorder emergencies: diagnosis and treatment. Cham: Springer International Publ.; 2022. p. 15–33. doi:10.1007/978-3-030-75898-1_2.
Olszewska DA, Shetty R, Geetha TS, Ramprasad VL, Lang AE, Kukkle PL. Oculogyric crisis phenotype of levodopa‐induced ocular dyskinesia. Mov Disord Clin Pract. 2022;9(3):390–3. doi: 10.1002/mdc3.13416.
Grover S, Sarkar S, Avasthi A. Clinical practice guidelines for management of medical emergencies associated with psychotropic medications. Indian J Psychiatry. 2022;64(Suppl 2):S236–51. doi: 10.4103/indianjpsychiatry.indianjpsychiatry1013_21.
Koban Y, Ekinci M, Cagatay HH, Yazar Z. Oculogyric crisis in a patient taking metoclopramide. Clin Ophthalmol. 2014;8:567–9. doi: 10.2147/OPTH.S60041.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2026 Helen Susanto, Christian Joseph Tanuwidjaja
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
