Treatment includes placing an eyepatch over the unaffected the eye and repeating the A1c test. The eyepatch is placed on the unaffected eye so that the brain does not favor the unaffected eye once the diplopia has resolved. The A1c level is checked to see if the patient is taking the proper steps to control diabetes to reverse the effects of NEG on CN III.
The patient in this case did not have ptosis and had a functioning downgaze. These findings indicate that the levator palpebrae superioris and inferior rectus muscles are still functional. This patient seems to have only selective muscular dysfunction of CN III, most likely because the cause of his CN III palsy is diabetic. Thus, ischemic changes may have affected only selected blood vessels, leading to select fibers of CN III to be involved and causing a partial CN III palsy.
A follow-up appointment in 3 months was scheduled for this patient to reassess his diplopia. In the meantime, he was advised to wear an eyepatch on the unaffected eye and to strictly adhere to his diabetes medications and diet. Because he states that his vision has been improving since his hospitalization, the CN III palsy will probably have resolved by the next appointment.
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Cite this: Muthunivas Muthuraj, Shailesh Rajguru. Facial Spasms in a Man Recently Released From the Hospital - Medscape - May 05, 2022.