Incidence of pupillary involvement, course of anisocoria and ophthalmoplegia in diabetic oculomotor nerve palsy

Abstract

Aims:To derive a reliable estimate of the frequency of pupillary involvement and to study the patterns and course of anisocoria in conjunction with ophthalmoplegia in diabetes-associated oculomotor nerve palsy.Materials and Methods:In this prospective analytical study, standardized enrolment criteria were employed to identify 35 consecutive patients with diabetes-associated oculomotor nerve palsy who were subjected to a comprehensive ocular examination. Standardized methods were used to evaluate pupil size, shape, and reflexes. The degree of anisocoria, if present and the degree of ophthalmoplegia was recorded at each visit.Results:Pupillary involvement was found to be present in 25.7% of the total number of subjects with diabetic oculomotor nerve palsy. The measure of anisocoria was < 2 mm, and pupil was variably reactive at least to some extent in all cases with pupillary involvement. Majority of patients in both the pupil-involved and pupil-spared group showed a regressive pattern of ophthalmoplegia. Ophthalmoplegia reversed much earlier and more significantly when compared to anisocoria.Conclusions:Pupillary involvement in diabetes-associated oculomotor nerve palsy occurs in about 1/4th of all cases. Certain characteristics of the pupil help us to differentiate an ischemic insult from an aneurysmal injury to the 3rd nerve. Ophthalmoplegia resolves much earlier than anisocoria in diabetic oculomotor nerve palsies.

Microvascular Non-Arteritic Ocular Motor Nerve Palsies—What We Know and How Should We Treat?

“…15 Of note, approximately 60% of patients with non-microvascular palsies also had vascular risk factors.…”

“…21 In a prospective study of 35 patients with diabetes associated third nerve palsy, 77% had headache and 49% periocular pain. 15 …”

“…Dhume and Paul reported on 35 patients, of whom 9 (26%) had minor pupil dilatations of 1 to 2 mm, and Jacobsen found that 10 of the 26 (38%) patients had minor pupil dilatation (1 mm). 15,25 The significance of minor degrees of anisocoria has to be questioned because 1 mm differences can be physiological. This is supported by a Japanese study of 63 isolated third nerve palsies (39 were aged 50 years).…”

Clinical signs, imaging findings, and outcome in twelve cats with internal ophthalmoparesis/ophthalmoplegia

“…Internal ophthalmoparesis/ophthalmoplegia is more commonly reported in the human literature. It has been reported secondary to a diabetic neuropathy, autoimmune disease, ophthalmoplegic migraine, trauma, cavernous sinus thrombosis, and compressive lesions such as intracranial aneurysms and space‐occupying lesions …”

Incidence of pupillary involvement, course of anisocoria and ophthalmoplegia in diabetic Oculomotor nerve palsy

“…So how was it decided that only diabetes is the cause of Oculomotor palsy? [ 1 ] Was there any co-relation between the status of systemic diseases at presentation and follow-up, and course of anisocoria and ophthalmoplegia? If no, then can the pupillary involvement be attributed only to diabetes?…”