Incidence of Recurrent Ocular Motor Nerve Palsies

Abstract

A review of the case notes of 600 patients who had attended the Ocular Motility Clinic at St Paul's Eye Hospital in Liverpool between 1976 and 1990 revealed 19 cases of recurrent ocular motor nerve palsies. Recurrent isolated single nerve palsies without other neurological involvement occurred in 12 patients and accounted for 42 of a total of 51 palsies. All recovered completely with a mean duration of 3.00 months. Five were non-insulin dependent diabetics and two had a pre-diabetic curve on glucose tolerance testing. Five patients were labelled as benign, cause unknown.

Involvement of two or more cranial nerves, or other neurological signs were present in seven patients with a total of nine palsies. Three of these failed to recover and one recovered only partially. Excluding these, the mean duration of the five palsies which did recover was 5.5 months. There were two cases of cerebro-vascular accident and two of multiple sclerosis and one each of trigeminal schwannoma, ophthalmoplegic migraine, and cause unknown. The authors suggest that diabetes must be excluded in patients with isolated recurrent ocular motor nerve palsies. The occurrence of other neurological symptoms or signs or involvement of more than one nerve makes this diagnosis highly unlikely and patients should be investigated accordingly.

Key Words:

• recurrent ocular motor nerve palsies
• isolated palsies
• diabetes mellitus