Anxiety Disorder and Alternating Bilateral Ptosis as the First Symptoms of Diabetes: A Case Report

Introduction: Long-term diabetes may cause oculomotor nerve palsy and anxiety disorder. Diabetic oculomotor nerve palsy is usually accompanied by diplopia, ptosis and eye movement disorders. The oculomotor nerve is often separated into superior and inferior divisions; diabetic third cranial nerve palsy may affect either division in isolation. However, anxiety disorder and alternating bilateral ptosis as the first symptoms of diabetes are extremely rare. Case Presentation: This case report describes a 63-year-old female patient who was admitted to the hospital for anxiety disorder with bilateral alternating ptosis. The patient had no diplopia or other new focal neurological symptoms. A neurological examination revealed left upper eyelid ptosis; other findings were negative. Except for hyperglycemia (13.96 mmol/L) and glycated hemoglobin (7.9%), laboratory tests showed no other abnormalities. The patient eventually recovered in a short time after a comprehensive treatment, including effective blood glucose control, microcirculation improvement and anxiety management. Conclusion: The upper eyelid droop caused by long-term diabetes may result in anxiety disorder. A comprehensive treatment may be considered for the patients admitted to the hospital for diabetes and its vascular neuropathy.