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Abstract
Extraocular motility disorders may occur in patients with diabetes, secondary to diabetic neuropathy, involving the third, fourth, or sixth cranial nerve. Rarely, simultaneous palsies of multiple extraocular nerves can occur. Diabetes is the underlying cause in 25-30% of patients aged 45 years and older who develop acute extraocular muscle palsy (Greco et al., 2009). In one study, 1% of patients with diabetes were found to have cranial nerve palsies, compared with only 0.13% of control subjects. Of these cases, 41% had a third nerve palsy. In another population-based study, patients with sixth cranial nerve palsy were six times more likely to have diabetes (Jeganathan et al., 2008). Patients with extraocular palsies present with binocular diplopia. Pupil sparing is an important diagnostic feature in diabetes-related third cranial nerve palsy, distinguishing it from surgical causes, such as intracranial aneurysm or tumor. In diabetic cranial nerve palsies, recovery of extraocular muscle function generally occurs within 3 months