Management of Diabetic Retinopathy and Other Ocular Complications in Type 1 Diabetes

Abstract

Patients with diabetes may present with a sudden onset of diplopia (double vision). This is usually caused by a paresis of one of the extraocular muscles due to microvascular damage to the third, fourth, or the sixth cranial nerves [3,4]. When the extraocular muscle deficit is due to microvascular complications of diabetes the prognosis is good. Recovery of ocular motor function generally begins within three months of onset and recovery is usually complete. Although the diplopia can be debilitating, due to the generally limited course of these complaints, patients can usually be effectively managed conservatively with eye patching. When diplopia is from large divergence of the visual axes, patching one eye is the only practical short-term solution. When the deviation is smaller, the diplopia often can be resolved by using glasses with a horizontal or vertical prism or both. Surgery is rarely indicated. If patients do not recover from a cranial nerve palsy within 6-12 months, eye muscle surgery to treat persistent and stable angle diplopia should be considered. These patients should consult with a neuro-ophthalmologist for continuing care.