Ophthalmoplegia in Diabetes Mellitus

THE OCCURRENCE OF OCULAR NERVE pa-ralysis in a diabetic patient presents a dilemma from diagnostic, prognostic, and therapeutic points of view. When the ophthalmoplegia is a manifestation of diabetic neuropathy, a benign, self-limited course is to be expected. The presenting symptoms, however, may be consistent with serious life-threatening conditions such as intracranial neoplasms and aneu-rysms, which can also occur in diabetics. For complete evaluation it may be neces-sary to perform cerebral arteriography or pneumoencephalogram, either of which im-plies inherent risks. Whether ophthalmo-plegia in the diabetic is an indication for these procedures depends upon a careful evaluation of the individual case. Identifica-tion of the characteristics of diabetic oph-thalmoplegia is important therefore. Several of these distinctive features have been ana-lyzed separately in the literature. Empha-sis has been given to pupillary sparing in diabetic third-nerve paralysis (1, 2), and the disappearance of the ophthalmoplegia within a period of weeks to months has been considered typical (3). To confuse the issue, the presence of associated ipsi-lateral headache, pain in the forehead, or pain in the eye—all of which are charac-teristic of internal carotid or posterior communicat ing artery aneurysms (4)—has also been described in diabetic ophthalmo-plegia by Jackson (5), W a i n d (6), Lincoff and Cogan (7), and others (8-10). It is the purpose of this report to review the clinical features of 27 episodes of dia-betic ophthalmoplegia in 24 patients in an a t tempt to further delineate the clinical picture and possible pathogenesis. T h e dif-ferential diagnosis of other entities causing disturbances of ocular motility in diabetic patients is also considered.