Clinical Features of Ischemic Ophthalmoplegia caused by Diabetes Mellitus or Hypertension

ABSTRACT

PURPOSE: This study is to evaluate the clinical features of ischemic ophthalmoplegia including the frequency of the paralyzed cranial nerve, the difference in frequency according to the causative disease, the clinical feature of the iridoplegia in cases of the third cranial nerve involvement, and the feature and time of recovery. METHODS: We retrospectively reviewed the medical records of 26 eyes of 26 patients who had been diagnosed with ischemic ophthalmoplegia caused by diabetes mellitus (DM) or hypertension (HT). RESULTS: Twelve patients had DM, 5 patients had HT, and 9 patients had both diseases. Three patients were revealed to have DM or HT during the work-up for searching the cause of ophthalmoplegia. The third cranial nerve was most frequently paralyzed, followed by the 6th and 4th cranial nerves. The opthalmoplegia was preceded or accompanied by ocular pain or headache in 10 patients. In patients with the third cranial nerve paresis, ptosis was the first to be recovered and adduction limitation was the last to be recovered. Of the 3 patients who had iridoplegia, one patient with complete iridoplegia did not recover completely until 9 months whereas 2 patients with incomplete iridoplegia had complete recovery after one and two months, respectively. Seventy-three point seven percent of patients with ischemic ophthalmoplegia completely recovered 4.3 months after onset, and there was no difference in the recovery time among the paralyzed nerves. CONCLUSIONS: There was no difference in the frequency of the paralyzed nerve according to the causative disease, and the complete iridoplegia showed slower recovery than incomplete one. Most patients with ischemic ophthalmoplegia caused by DM or HT recovered spontaneously and did not need any further treatment.