Oculomotor Palsy in Diabetic Patients: Think of Diabetic Neuropathy — A Series of 4 Cases and Review of the Literature

Abstract Introduction: Oculomotor palsies are a rare manifestation of focal diabetic neuropathies. Their clinical presentation may mimic serious neurological conditions, making diagnosis challenging. Objective: To report a series of four cases of oculomotor palsy in diabetic patients and to analyze their clinical, diagnostic, therapeutic, and evolutionary characteristics in light of the literature. Patients and Methods: A retrospective descriptive study including four diabetic patients presenting with oculomotor palsy, managed in a university endocrinology department. Results: All patients had long-standing, poorly controlled type 2 diabetes. The affected nerves were the abducens nerve (VI) in two cases and the oculomotor nerve (III) in two cases. Brain imaging was normal in all patients. Clinical evolution was favorable after optimization of glycemic control, with progressive recovery over several weeks to months. Conclusion: Diabetic oculomotor palsy should be considered in any acute oculomotor disorder in diabetic patients. Neuroimaging is mandatory to exclude compressive causes. Prognosis is generally favorable with conservative management.