Table 1  Comparison of the different diseases processes leading to painful ophthalmoplegia
Recurrent painful ophthalmoplegic neuropathyTolosa–Hunt syndromeDiabetic ocular neuropathy
Location of painUnilateral* or bilateral UnilateralUsually unilateral
MRIMay show nerve root enhancement*50% are normal
50% show abnormalities of orbit, cavernous sinus or superior orbital fissure
Usually normal
TimingHeadache may precede ophthalmoplegia by up to 14 daysHeadache precedes ophthalmoplegia by 2–3 daysVariable
Mean age at onset (years)45.856.362.8
Involvement of cranial nervesMean %Mean %Mean %
 • CN3807473
 • CN4405635
 • CN6405950
 • Ptosis204162
 • Pupil involvement02227
Mean time to total recovery3 weeks2 months3–4 months
  • Data from Hung CH et al 7; *data from Gelfand et al 3; †data Lal et al 2.