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Cranial mononeuropathy III - diabetic type

Diabetic third nerve palsy; Pupil-sparing third cranial nerve palsy

 

This diabetic type of cranial mononeuropathy III is a complication of diabetes. It causes double vision and eyelid drooping.

Causes

 

Mononeuropathy means that only one nerve is damaged. This disorder affects the third cranial nerve in the skull. This is one of the cranial nerves that control eye movement.

This type of damage may occur along with diabetic peripheral neuropathy. Cranial mononeuropathy III is the most common cranial nerve disorder in people with diabetes. It is due to damage to the small blood vessels that feed the nerve.

Cranial mononeuropathy III can also occur in people who don't have diabetes.

 

Symptoms

 

Symptoms may include:

  • Double vision
  • Drooping of one eyelid (ptosis)
  • Pain in the head or behind the eye

 

Exams and Tests

 

An examination of the eyes will determine whether only the third nerve is affected or if other nerves have also been damaged. Signs may include:

  • Eyes that are not aligned
  • Pupil reaction that is almost always normal

Your health care provider will do a complete examination to determine the possible effect on other parts of the nervous system. Depending on the suspected cause, you may need:

  • Blood tests
  • Tests to look at blood vessels in the brain (cerebral angiogram, CT angiogram, MR angiogram)
  • MRI or CT scan of the brain
  • Spinal tap (lumbar puncture)

You may need to be referred to a doctor who specializes in vision problems related to the nerves in the eye (neuro-ophthalmologist).

 

Treatment

 

There is no specific treatment to correct the nerve injury.

Treatments to help symptoms may include:

  • Close control of blood sugar level
  • Eye patch or glasses with prisms to reduce double vision
  • Pain medicines
  • Surgery to correct eyelid drooping or eyes that are not aligned

Some people may recover without treatment.

 

Outlook (Prognosis)

 

Many people get better over 3 to 6 months. Some people have permanent eye muscle weakness.

 

Possible Complications

 

Complications may include:

  • Permanent eyelid drooping
  • Permanent vision changes

 

When to Contact a Medical Professional

 

Call your provider if you have double vision and it does not go away in a few minutes, especially if you also have eyelid drooping.

 

Prevention

 

Controlling your blood sugar level may reduce the risk of developing this disorder.

 

 

References

Brownlee M, Aiello LP, Cooper ME, Vinik AI, Plutzky J, Boulton AJM. Complications of diabetes mellitus. In: Melmed S, Polonsky KS, Larsen PR, Kronenberg HM, eds. Williams Textbook of Endocrinology. 13th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 33.

Rucker JC, Thurtell MJ. Cranial neuropathies. In: Daroff RB, Jankovic J, Mazziotta JC, Pomeroy SL, eds. Bradley's Neurology in Clinical Practice. 7th ed. Philadelphia, PA: Elsevier; 2016:chap 104.

 
  • Central nervous system

    Central nervous system - illustration

    The central nervous system is comprised of the brain and spinal cord. The peripheral nervous system includes all peripheral nerves.

    Central nervous system

    illustration

    • Central nervous system

      Central nervous system - illustration

      The central nervous system is comprised of the brain and spinal cord. The peripheral nervous system includes all peripheral nerves.

      Central nervous system

      illustration

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            Review Date: 5/30/2016

            Reviewed By: Amit M. Shelat, DO, FACP, Attending Neurologist and Assistant Professor of Clinical Neurology, SUNY Stony Brook, School of Medicine, Stony Brook, NY. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.

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