Consecutive cyclic esotropia � A case report

Cyclic esotropia, a rare condition of obscure etiology characterized by regularly alternating periods of esotropia and orthophoria. We present a case of a 7-year-old boy who underwent surgical correction for intermittent exotropia elsewhere and developed esotropia with cyclic pattern post-operatively. Initially the cycle was of half-day orthophoria and half-day esotropia, which later became one full day of esotropia and one day of orthophoria. During re-surgery, right lateral rectus was found to have a stretched scar which was resected and then advanced and medial rectus was recessed. Post-surgery the child was orthophoric without cyclic pattern.

A Case of Cyclic Esotropia after Psychological Trauma

PURPOSE: To report a case of cyclic esotropia after psychological trauma that resolved spontaneously without any surgical treatment. METHODS: An 8-year-old boy developed blepharoptosis, limitation of abduction, and esotropia with headache and vomiting after psychological trauma. Brain MRI, cerebrospinal fluid examination, and EEG (electroencephalogram) showed no significant abnormalities. The ptosis and limitation of abduction were resolved gradually, but esotropia persisted in a cyclic pattern. RESULTS: During follow-up, the 96-hour cycle of esotropia was gradually shortened to a 48-hour and then to 24-hour cycle. At final follow-up, the cyclic esotropia had disappeared completely and the patient has been orthotroric for more than 4 years. CONCLUSIONS: Cyclic esotropia may occur after psychological trauma and may resolved spontaneously without any surgical treatment.

Cyclic Esotropia Following Ocular Surgery

The cause of cyclic strabismus is not clear but is assumed to be an abnormality of the biological clock mechanism. Secondary factors, combined with surgery or trauma as well as unknown causes stimulate its occurrence and may be followed by the periodicity of strabismus. We report postoperative follow-up results of 4 cases of cyclic esotropia following surgery. Two cases (case 1 and 2), who developed cyclic esotropia after surgery for intermittent exotropia, show good postoperative alignment without periodicity. But in case 3, originally treated for intermittent exotropia after receiving treatment for consecutive esotropia, the patient reverted to original condition. In case 4, originally treated for congenital glaucoma and receiving secondary treatment for cyclic esotropia, the cyclic esotropia was recurred. After surgery for consecutive cyclic strabismus, it is necessary to follow up for a long time.

Consecutive Cyclic Esotropia Developing after Strabismus Surgery for Intermittent Exotropia

Cyclic esotropia is a very rare and specific entity. Cyclic esotropia is sometimes developed in a patient following strabismus surgery for intermittent exotropia. The term of 'consecutive cyclic esotropia' was suggested for this clinical entity. Three cases of consecutive cyclic esotropia have been reported in U.S.A., Canada and Japan, and only one case has been reported in Korea. We experienced two cases of consecutive cyclic esotropia which developed 10 months and 1 year after strabismus surgery for intermittent exotropia at our hospital. The patients underwent bimedial rectus recessions and results are uniformly good, with straight eyes and fusion. The cyclic pattern does not recur. We report these patients with a review of the literature.

Consecutive Cyclic Esotropia Following Surgery for Intermittent Exotropia

Cyclic esotropia is a rare condition, first mentioned by Burian in 1958, in which orthophoria is regularly followed by constant deviation on rhythmic pattern. The periodicity would suggest a biologial clock mechanism. Consecutive cyclic esotropia following strabismus surgery is extremely rare. Only three cases of consecutive cyclic esotropia following surgery for intermittent exotropia have been reported We report one case of consecutive cyclic esotropia in an 8-year-old girl who underwent surgery for intermittent exotropia. The periodic esodeviation was treated with bimedial rectus recession. We suggest the overcorrection after surgery for intermittent exotropia would cause the periodicity by biological clock mechanism when the biorhythm of the patient is in an unstable and dangerous state.