A case of oculomotor nerve paralysis for which a treatment plan was difficult to decide

Abstract

A 71-year-old man presented with diplopia and ptosis of the right eyelid, and a serious of examinations resulted in a diagnosis of right peripheral oculomotor nerve paralysis. He had sinusitis only on the paralyzed side, so we considered opening the maxillary sinus by endoscopic sinus surgery. However, a preoperative evaluation revealed complete occlusion of the internal carotid artery, so we decided against aggressive surgical treatment, considering the risk of complications associated with the introduction of general anesthesia. After consulting with the Department of Neurology at our hospital, we suggested decompression and drainage by puncturing the natural foramen of the maxillary sinus under local anesthesia, followed by infection control and anti-inflammatory treatment centered on steroids for acute neuropathy. Thanks to additional efforts to control the blood glucose level and improve the microcirculation with antiplatelet drugs, the patient was able to open his eyes after about one month, and his diplopia gradually improved with a subsequently relatively good course. It was thus considered important to consider the optimal treatment policy on a case-by-case basis, taking into consideration the underlying disease and complications.