TY - CHAP M1 - Book, Section TI - Oculogyric Crisis A1 - Shah, Ashish A1 - Sobolewski, Brad A1 - Mittiga, Matthew R. A2 - Knoop, Kevin J. A2 - Stack, Lawrence B. A2 - Storrow, Alan B. A2 - Thurman, R. Jason PY - 2021 T2 - The Atlas of Emergency Medicine, 5e AB - Oculogyric crisis (OGC) is the most common of the ocular dystonic reactions. It includes blepharospasm, periorbital twitches, and protracted staring episodes. It usually occurs as a side effect of neuroleptic drug treatment. OGC represents approximately 5% of dystonic reactions. The onset of a crisis may be paroxysmal or stuttering over several hours. Initial symptoms include restlessness, agitation, malaise, or a fixed stare followed by the more characteristically described maximal sustained upward deviation of both eyes. The eyes may also converge, deviate upward and laterally, or deviate downward. The most frequently reported associated findings are backward and lateral flexion of the neck, widely opened mouth, tongue protrusion, and ocular pain. Episodes generally last minutes but can range from seconds to even hours. A wave of exhaustion follows some episodes. Other features noted during attacks include eye blinking, lacrimation, pupil dilation, drooling, facial flushing, vertigo, anxiety, and agitation. Several medications have been associated with the occurrence of OGC: cetirizine, neuroleptics, amantadine, benzodiazepines, carbamazepine, chloroquine, levodopa, lithium, metoclopramide, and nifedipine. Careful history and physical examination should exclude the possibility of focal seizures, meningitis, encephalitis, head injury, conversion reaction, Parinaud syndrome, and other types of movement disorders. SN - PB - McGraw-Hill CY - New York, NY Y2 - 2024/11/12 UR - accessmedicine.mhmedical.com/content.aspx?aid=1181044714 ER -