Cyclic vertical deviation after ocular myositis and treatment by recession of the inferior rectus muscle

Abstract

The aetiology of cyclic eye deviations, most of them occurring in a constant rhythm, is not known. The association with lesions of the central nervous system indicates a primary central dysregulation of a "biological clock". Their well-known occurrence, however, after squint surgery and, as in the present case, after orbital myositis, suggests that alteration of peripheral structures may contribute to a central dysregulation. Squint surgery seems to be the treatment of choice, even in rare cases with vertical deviations.

Cyclic exotropia associated with retinitis pigmentosa

“…Regarding the binocular status of cyclic deviations, most of the patients showed normal binocularity on normal or "non-squinting" days, and no binocular function including diplopia or suppression on the squinting day [1,4,5,7,8,[10][11][12]. Although there was a report of recurrence of cyclic esotropia after surgical correction [2], most cases are treated successfully with strabismus surgery [5,7,8].…”

“…There have been some reports describing the clinical manifestation of cyclic deviations [1][2][3][4][5][6][7][8][9][10][11][12]; however, there have been no case reports of cyclic exotropia in the English ophthalmic literature. We believe our case report could be a start to collecting data about cyclic exotropia in English ophthalmic literature.…”

“…Most cyclic deviations develop after ocular myositis [1], unilateral traumatic aphakia [3], traumatic sixth nerve palsy [5], and craniofacial surgery [7], strabismus surgery for intermittent exotropia [8], or are associated with central nervous system disease [9]. Regarding the binocular status of cyclic deviations, most of the patients showed normal binocularity on normal or "non-squinting" days, and no binocular function including diplopia or suppression on the squinting day [1,4,5,7,8,[10][11][12].…”

“…Cyclic eye deviations include cyclic esotropia, superior oblique paresis, and cyclic vertical deviations [1][2][3][4][5][6][7][8][9][10][11][12]. The etiology of cyclic eye deviation remains unknown.…”

Acquired cyclic exotropia and hypotropia

“…5 Cyclic vertical deviations and cyclic exotropia appear to be very rare. [1][2][3][4] Cyclic vertical deviation has been described by Metz and colleagues 4 in a patient after craniofacial surgery. Clarke and Scott 11 described cyclic third nerve palsy.…”