Diabetic Mononeuritis: Isolated Extrinsic Paralysis of the III

Abstract

Oculomotor paralysis is a rare complication of diabetes. It is a rare form of diabetic neuropathy, with a prevalence of 1 to 14% in diabetics. This is a 52-year-old patient with no known personal history, who presented himself in ophthalmological consultation for left ocular pain and fall of the upper left eyelid, occurred 6 days ago and rapidly progressive in an atraumatic context. Objective ophthalmological examination a moderate left ptosis, with incomplete ophthalmoplegia sparing abduction and twists, without vicious attitude. Visual acuity at a distance without correction was 6/10 in both eyes, P3. At bio microscopy, RPM kept bilaterally, without surface disturbance with normal anterior and posterior segments. This was an incomplete paralysis of the extrinsic component of the III. Emergency radiological checkup ruled out a central vascular and neurological cause. The etiological biological assessment finds fasting blood glucose high at 1.92 g/l. It is sent to the diabetologist for investigations. The degenerative assessment is normal but with a glycated hemoglobin at 10.5%, testifying to an unknown diabetic. It is retained the diagnosis of a paralysis of III incomplete inaugural type 2 diabetes. The evolution after 2 months was marked by the progressive regression of its paralysis after glycemic balance and correction of risk factors. Oculomotor paralysis is not uncommon during diabetes, it is necessary to think about it during etiological assessment for early and adapted management.