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Comparative Study
. 2013 Jan-Feb;61(1):13-7.
doi: 10.4103/0301-4738.99999.

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

Kaushik U Dhume  1 , Kiruba E Paul
Affiliations
Comparative Study

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

Kaushik U Dhume et al. Indian J Ophthalmol. 2013 Jan-Feb.

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 1/4 th of all cases. Certain characteristics of the pupil help us to differentiate an ischemic insult from an aneurysmal injury to the 3 rd nerve. Ophthalmoplegia resolves much earlier than anisocoria in diabetic oculomotor nerve palsies.

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Conflict of interest statement

Conflict of Interest: None declared.

Figures

Figure 1
Figure 1
Course of anisocoria [The graph represents the degree of anisocoria for each of the nine patients (A-I) with pupillary involvement at each visit. Patient ‘C’ and ‘E’ were lost to follow-up at 2nd and 3rd visit, respectively]
Figure 2
Figure 2
Time taken to develop maximum anisocoria (The last data point plotted for each patient (A-I) represents the maximum anisocoria recorded)
Figure 3
Figure 3
Course of ophthalmoplegia [The graph represents the grades of ophthalmoplegia of each of the 9 patients (A-I) with pupillary involvement at each visit. Patient ‘C’ and ‘E’ were missed for follow-up at 2nd and 3rd visit, respectively]
See this image and copyright information in PMC

References

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