Diplopia and Ptosis

[...]nerve palsy typically manifests as diplopia and ptosis. The oculomotor nucleus, located in the midbrain, can be affected if the blood supply to the midbrain is decreased.6 Patients may also present with nausea, vertigo, and other cranial nerve or neurologic deficits. Because the levator palpebrae are innervated by a single central subnucleus, a nuclear lesion would cause bilateral ptosis. Summary Table Condition Characteristics Aneurysm of the posterior communicating artery May compress the oculomotor nerve, leading to third nerve palsy; pupil constriction is typically impaired Diabetic third nerve palsy Caused by microvascular infarction of the blood supply to the oculomotor cranial nerve; manifests as inferolateral deviation of the eye with diplopia and ptosis; recovery generally occurs over weeks to months, although deficits that are present after six months are usually permanent Myasthenia gravis Caused by autoimmune destruction of postsynaptic acetylcholine receptors; may manifest as pupil-sparing third nerve palsy with ptosis, but usually also affects multiple other nerves; application of ice may relieve ptosis Orbital myositis Inflammation of at least one extraocular muscle; manifests as orbital pain, diplopia, and conjunctivitis; pupil is spared; diagnosis confirmed with neuroimaging Vertebrobasilar occlusion May affect the oculomotor nucleus located in the midbrain, resulting in nausea, vertigo, and other cranial nerve deficits; bilateral ptosis also occurs Address correspondence to Kristine J. Pfeiffer, DO, at Kristine.