Axonal and myelin changes of the degenerative type were found in the extra-ocular muscles of 21 out of 23 diabetics of all ages (30--74 years). In all these 21 cases both axonal and myelin changes were observed; they did not correlate with the duration, degree of severity or treatment of diabetes. In 19 of the 23 cases (82.6%) nervous changes were accompanied by vascular changes. In 10 controls (50--80 years) nervous and vascular changes were of a slight degree. The findings of the alteration of peripheral nerve endings in the extra-ocular muscle corroborate and complete the description of the central nervous changes in diabetics with ophthalmoplegia given by several authors. We agree with Domínguez et al. that ophthalmoplegia may appear in the preclinical stage of diabetes and may be the first manifestation of the disease.

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