Unilateral Oculomotor Nerve Palsy Induced by Combination Therapy of Interferon-.ALPHA.2b and Ribavirin

Abstract

A 42-year-old female patient experienced diplopia after two weeks of daily administration of interferon-2b and ribavirin for chronic active hepatitis C. Administration of these drugs had continued further three times a week after that and the diplopia persisted. Since brain MRI and CT angiography did not show any abnormalities, she was referred to our hospital. Neurological examination was negative except for left oculomotor nerve palsy (Fig. 1A). Blood and cerebrospinal fluid examinations and peripheral nerve conduction velocity were normal. Her oculomotor nerve palsy improved promptly after the discontinuation of interferon-2b and ribavirin, and the diplopia completely recovered after three weeks, but a slight left ptosis remained (Fig. 1B). Although interferon may cause neuropsychiatric disturbances, the incidence is quite rare. Only two cases with oculomotor nerve palsy have been reported abroad (1, 2), and this is the first Japanese case induced by combination therapy of interferon-2b and ribavirin.

Ocular side effects of antirheumatic medications: a qualitative review

“…Case reports of episcleritis are associated with interferon alpha-2b in the treatment of head and neck mucosal melanoma 106. There are also reports of non-arteritic anterior ischaemic optic neuropathy, neuromyelitis optica, optic neuritis, retinopathy, cystoid macular oedema, Vogt–Koyanagi–Harada disease, abducens palsy, oculomotor nerve palsy, glaucoma and retinal vein thrombosis reported in patients treated with interferon alpha 107–129…”