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

Abstract

Dear Editor, After going through the article published in the January 2013 issue on “Incidence of pupillary involvement, course of anisocoria and ophthalmoplegia in diabetic Oculomotor nerve palsy” I have few queries: Cases recruited in the study had multiple systemic diseases other than diabetes, which can also cause ischemic Oculomotor palsy independently. 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?[2,3] If the study was not a masked trial, then there could have been subjective variation in measuring the pupil size and reaction, which can alter the final inference. Does the absence of diabetic retinopathy, not point towards other cause of nerve palsy, as the pathogenesis of both is considered to be microangiopathy.[4,5] I would also like to suggest that near vision, near point of accommodation of the involved eye could have been taken into account for analyzing the course of pupillary involvement. Appreciable fact about the study is that if there is anisocoria of <2 mm in nerve palsy cases then we need not subject the patient to costly Neuro-imaging.