Oculogyric crises are characterized by sustained contractions of the eye muscles causing tonic, conjugate deviations of the eyes, typically upward. They can last from minutes to hours and may be associated with other dystonic symptoms. Oculogyric crises are most often caused by dopamine-receptor blocking agents as a potential complication, and are treated with anticholinergic drugs which work quickly to ameliorate symptoms by addressing the underlying relative cholinergic overactivity caused by the hypodopaminergic state.

1. Oculogyric Crises
Summarized from:
Slow EJ, Lang AE. Oculogyric crises: a review of phenomenology, etiology,
pathogenesis, and treatment. Movement Disorders. 2017 Feb;32(2):193-202.

2. Outline:
 Introduction
 Etiology
 Pathophysiology
 Diagnostic Criteria
 Differential diagnosis
 Diagnostic Approach
 Treatment
 Summary

3. Introduction
 OGC: an unusual type of dystonic movement disorder characterized by
paroxysmal, tonic, conjugate, ocular deviations caused by sustained
contractions of ocular muscles
 Typical episodes last minutes to hours, involve deviation of eyes most often
upward and can be associated with other dystonic symptoms
 A potential complication of medications, most often dopamine-receptor
blocking agents (DRBAs)

5. Pathophysiology

6. Diagnostic Criteria

7. Differential Diagnosis

8. Diagnostic Approach

9. Treatment
 Anticholinergics are the mainstay of treatment in drug-induced OGC
 One theory is that the hypodopaminergic state results in a relative cholinergic
overactivity
 Intravenous anticholinergics or diphenhydramine are recommended
treatments in acute distonic reactions, typically working quickly (often
minutes) to ameliorate the symptoms
 Benzodiazepines, including diazepam and clonazepam, may also be of benefit
in OGC caused by neuroleptics
 In the neurometabolic disorders, dopamine replacement can completely
abolish the occurrence of OGC over time

10. Summary
 A rare acute dystonic reaction
 Tonic upward gaze
 Due to DRBA / neuroleptic agent or neurometabolic disorders
 Deficiency of dopamine metabolism enzymes
 Hypodopaminergic  relative hypercholinergic
 Treatment: Anticholinergics (diphenhydramine)