The Journal of Medical Sciences

Register      Login

VOLUME 9 , ISSUE 1-4 ( January-December, 2023 ) > List of Articles


Uncontrolled Diabetes Mellitus Presenting as Isolated Abducens Nerve Palsy

Debarchana Sarkar, P Mirudhubashini Swarup, Pooja Shashidharan

Keywords : Hypertension, Isolated abducens nerve palsy, Type 2 diabetes mellitus

DOI: 10.5005/jp-journals-10045-00229

License: CC BY-NC 4.0

Published Online: 08-05-2023

Copyright Statement:  Copyright © 2023; The Author(s).


Background: This case report demonstrates the acute onset of diplopia due to isolated abducens nerve palsy secondary to uncontrolled diabetes, presenting as ophthalmoplegia. Case description: A 55-year-old female with a history of type 2 diabetes mellitus (DM) and hypertension presented with sudden onset binocular horizontal diplopia in the past 15 days, which was greater at a distance and worsened on looking toward the right. Ophthalmological examination was unremarkable except for right eye abduction limitation on lateral gaze. Blood investigations revealed glycated hemoglobin (HbA1c)—11.8, fasting blood sugar (FBS)—271, postprandial blood sugar (PPBS)–385, and the rest of the reports were unremarkable. Fundoscopic examination of eyes was normal. Magnetic resonance imaging (MRI) brain and orbit were also normal. A diagnosis of isolated sixth nerve palsy (ISNP) secondary to uncontrolled diabetes was made. Subsequently, the patient was put on oral hypoglycemia agents, insulin, aspirin, and dark goggles with alternate eye occlusion therapy. Over the course of 4 days of hospital stay, the patient noticed a 20% improvement in her symptoms. Conclusion: It is important to consider sixth nerve palsy in poorly controlled diabetic patients presenting with diplopia with normal neurological findings.

  1. Elder C, Hainline C, Galetta SL, et al. Isolated abducens nerve palsy: update on evaluation and diagnosis. Curr Neurol Neurosci Rep 2016;16(8):69. DOI: 10.1007/s11910-016-0671-4
  2. Garay PAS, Zerpa R, Zuniga G, et al. MON - 701 uncontrolled diabetes presenting as isolated sixth nerve palsy. J Endocr Soc 2020;4(1):MON-701. DOI: 10.1210/jendso/bvaa046.154
  3. Asbury AK, Aldredge H, Hershberg R, et al. Oculomotor palsyindiabetes mellitus: a clinico-pathological study. Brain 1970;93(3):555–566. DOI: 10.1093/brain/93.3.555
  4. Watanabe K, Hagura R, Akanuma Y, et al. Characteristics of cranial nerve palsies in diabetic patients. Diabetes Res Clin Pract 1990;10(1):19–27. DOI: 10.1016/0168-8227(90)90077-7
  5. Loscalzo J, Fauci AS, Kasper DL, Hauser SL, Longo DL, Jameson JL. Harrison's principles of Internal Medicine. 21st ed. New York: McGraw Hill; 2022
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.