Endocrine Abstracts

Introduction: We report a case of pupil sparing third nerve palsy caused by diabetes.

Case Presentation: A 68-year-old woman consulted for acute left upper lid ptosis appeared since 2 days ago. The patient complained of blurred vision and periorbital pain. No history of head trauma or infection was reported. The patient has been diagnosed with type II diabetes mellitus and arterial hypertension since 15 years. Ophthalmological examination revealed complete left ptosis, reactive pupillary reflex with deficient elevation, and adduction. The best-corrected visual acuity was 4/10 in both eyes. Anterior segment examination revealed bilateral cataract. Fundus examination didn’t show any signs of diabetic retinopathy. Neurological examination was normal. Brain magnetic imaging was unremarkable without intracranial mass lesions and acute infarction. Blood analyses showed hyperglycemia (320 mg/dl) and elevated glycated hemoglobin (11.7%) without other anomalies. A complete recovery of ptosis was achieved after 3 weeks of blood sugar control with control of other cardiovascular risk factors The diagnosis of diabetic third nerve palsy was made.

Discussion: Diabetic third nerve palsy is the most frequent complication of nerve palsy in diabetic patients. The incidence of nerve palsy increases with the duration of the disease, uncontrolled glucose levels and age of the patient. The main etiology is microvascular cranial nerve palsy with high vascular risk factors such as smoking, hypertension, hypercholesterolemia. Third nerve palsy is frequently incomplete with ptosis, divergence of the affected eye, and paralysis eye movements such as adduction, elevation, and lowering without pupil involvement. Full recovery generally takes place at 6 months of follow up. Recurrences of third nerve palsy or other ocular motor nerve is possible.