Left Eye Movement Issues and Ear Heat: Possible Causes and Solutions

The left eye movement is not smooth, and there is a sensation of heat in the left inner ear?

Hello doctor, recently I have been experiencing difficulty in moving my left eye smoothly.
When I look up, my left eye appears asymmetrical compared to the right, and I have to exert a lot of effort to open my left eyelid to match the right.
I also feel a sensation of heat in my left inner ear.
This condition seems to have persisted for about six months, with the symptoms feeling more pronounced upon waking.
Recently, it seems to have worsened, with increased tightness in my left eye and a stronger sensation of heat in my left ear.
I am experiencing insomnia, dizziness, and palpitations.
There is a tightness in a muscle at the back of my left neck, and I feel soreness in my left brain and left eye.
What could be the cause of this? Which specialty should I consult for diagnosis?

Mr. Hsu, 20~29 year old female. Ask Date: 2017/01/19

Dr. Chen Taicheng reply Family Medicine

● Eye movement is controlled by three pairs of cranial nerves: the third oculomotor nerve, the fourth trochlear nerve, and the sixth abducens nerve.
These nerves are responsible for coordinating the movement of both eyes, with the third oculomotor nerve being the most crucial.
It also controls the opening and closing of the eyelids.
Based on your symptoms, it sounds like there may be oculomotor nerve palsy, which can lead to uncoordinated eye movement and ptosis (drooping) of the left eyelid.
Other rare conditions such as myasthenia gravis, eyelid trauma, brain disorders, or cervical nerve root issues could also cause eyelid drooping.
● The sensation of heat in the left ear should rule out external otitis, otitis media, or other inner ear diseases.
● Issues with vision and hearing can potentially lead to symptoms such as dizziness.
● Recommended specialties for consultation: ophthalmology (to examine eyelid drooping, eye misalignment, and poor coordination of both eyes) and otolaryngology; if necessary, further consultation with neurology to rule out dizziness, insomnia, or other underlying issues.
Wishing you good health, Dr.
Chen Tai-Cheng, Family Medicine, Taoyuan Hospital.

Reply Date: 2017/01/19

More Info

Based on your symptoms, it appears that you are experiencing a combination of ocular and auditory issues, specifically with your left eye and left ear. The symptoms you describe, including difficulty moving your left eye, a sensation of heat in your left ear, and associated feelings of tension, dizziness, insomnia, and palpitations, suggest that there may be underlying neurological or muscular issues at play.

The movement of the eye is primarily controlled by three cranial nerves: the oculomotor nerve (III), the trochlear nerve (IV), and the abducens nerve (VI). If you are experiencing difficulty moving your left eye and have to exert extra effort to keep your eyelid open, this could indicate a problem with the oculomotor nerve, which is responsible for most eye movements and eyelid elevation. Conditions such as oculomotor nerve palsy, myasthenia gravis, or even a structural issue affecting the cranial nerves could be contributing factors.

The sensation of heat in your left ear could be related to several conditions, including middle ear infections, inner ear disorders, or even referred pain from issues in the cervical spine or cranial nerves. The fact that you also experience dizziness and palpitations may suggest that there is a more systemic issue or that the symptoms are interconnected, possibly involving the vestibular system, which is responsible for balance and spatial orientation.

Given the complexity of your symptoms, it is advisable to consult with multiple specialists. Initially, you should see an ophthalmologist to evaluate the movement of your left eye and assess for any potential nerve damage or muscular disorders. They can perform tests to determine if there is an issue with the ocular muscles or the nerves controlling them.

Additionally, visiting an otolaryngologist (ENT) is crucial for addressing your ear symptoms. They can examine your ear for any signs of infection or other abnormalities and assess the relationship between your ear symptoms and your overall health. They may also investigate the possibility of Eustachian tube dysfunction, which can cause sensations of fullness or heat in the ear.

If both specialists find no clear diagnosis, it may be beneficial to see a neurologist. They can conduct further evaluations, including imaging studies like an MRI or CT scan, to rule out any neurological conditions that could be causing your symptoms, such as multiple sclerosis or a tumor affecting the cranial nerves.

In summary, your symptoms warrant a multidisciplinary approach. Start with an ophthalmologist and an ENT specialist, and based on their findings, consider a referral to a neurologist if necessary. It is essential to address these symptoms promptly, as they may indicate underlying conditions that require treatment. Please ensure you communicate all your symptoms clearly to each specialist to facilitate accurate diagnosis and management.

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