Unusual Presentation of an Uncommon Disease: 24-Hour Cyclic Esotropia

Abstract

Cyclic esotropia is an extremely uncommon form of strabismus. Classically, it follows a 48-hour cycle with 24 hours of orthotropia and 24 hours of manifest esotropia. We are reporting the first case of cyclic esotropia with a 24-hour cycle. A 7-year-old hyperopic female was seen with an esotropia of 6-month duration. Hyperopic glasses were prescribed by another ophthalmologist prior to our evaluation of the patient. While wearing her glasses, esotropia occurred during the morning and early afternoon. After 3.00pm, her eyes were “straight.” Many photographs were reviewed, confirming the esotropia pattern. Neurological evaluation was normal, including imaging and blood work to rule out thyroid pathology and myasthenia. After seeing the patient multiple times at different hours on different days, the diagnosis of cyclic esotropia was made. Bimedial recessions were performed with good results. The patient was still “straight” at distance and near 2 years after surgery.

Cyclic Esotropia Managed With Botulinum A Toxin Injections: A Report of Four Cases and Literature Review

“…However, variable cycle durations of three to five days have been reported [ 1 , 9 ]. A recent case report described the shortest cycle to date consisting of 12 hours of orthotropia alternating with 12 hours of esotropia for a complete cycle of 24 hours [ 24 ]. In the present report, the cycle duration was 48 hours for all cases, supporting the most commonly encountered cycle duration reported in the literature.…”

“…A medically free eight-year-old girl presented to her ophthalmologist two months after starting to experience inward eye deviations of the left eye. Her deviation had started in a cyclic manner with 24 hours of esotropia followed by 24 1A). Dilated funds examination was normal and cycloplegic refraction was unremarkable.…”