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A 59-year-old man developed a left pupil-sparing third nerve palsy related to diabetes that recovered gradually over 5 months; the only deficit remaining at 8 months was a trace underaction of adduction. Oculomotor synkinesis was evident at this time, manifest as left upper lid retraction on adduction and on downgaze. There were no signs of oculomotor or pupillary synkinesis. High-resolution magnetic resonance imaging of the third nerve pathway revealed no abnormality. Oculomotor synkinesis following diabetic third nerve palsy is extremely rare, with only one report in the literature to date.
Synkinesis may occur during the recovery phase of a traumatic third nerve palsy or after long-standing compression. The abnormal movements that constitute synkinesis may involve the upper lid, oculomotor system, and the pupil. Synkinesis is rare when the cause is ischemia1 and we have found only one previous report of synkinesis following diabetic third nerve palsy.2 Our report adds a second to the literature.
Barr D, Kupersmith M, Turbin R, Yang S, Iezzi R. Synkinesis Following Diabetic Third Nerve Palsy. Arch Ophthalmol. 2000;118(1):132–134. doi:
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