Acquired Adult Onset Cyclic Esotropia in Patients With Myopic Strabismus Fixus and Intraocular Lens Implantation.

Purpose/Background: Cyclic esotropia is a rare condition that mostly occurs in children, characterized by patterns of straight and strabismic days with a regular cycle of 24 to 96 hours. In this report, 2 patients of cyclic esotropia in adults who showed a regular 48-hour cycle of mild deviation on 1 day followed by a more severe deviation on the second day are presented. Methods: Clinical reports, clinical features, imaging findings, and surgical outcomes are presented. Results: In patient 1, a 42-year-old male with high myopia was diagnosed with progressive esotropia for 2 years. A medial and lateral rectus (LR) recession/resection was performed 9 months before. On day 1 after this surgery, a relatively mild esotropia was present which developed into a severe esotropia on day 2. Being diagnosed as cyclic esotropia with myopic strabismus fixus, he underwent a 4 mm re-recession of the medial rectus combined with a half-Jensen procedure in his right eye. After the second surgery, the cyclic pattern was no longer present. In patient 2, a 39-year-old female with high myopia had concomitant esotropia for 20 years. At 6 months following bilateral intraocular lens implantation for her high myopia, she demonstrated a cyclic strabismus. On day 1, a 25 prism dioptres esotropia was present, which increased to a 45 prism diopters esotropia on day 2. A 4 mm recession of the medial rectus and 6 mm resection of the LR was performed in her left eye. After surgery, the cyclic pattern disappeared. Conclusions: Cyclic esotropia can occur in adults with myopic strabismus fixus subjected to horizontal strabismus surgery and with concomitant strabismus following intraocular lens implantation for high myopia. Their cyclic strabismus consisted of a mild squint on day 1 which increased in severity on day 2. The extent of surgery required for correction was based upon the "severe esotropia" experienced on day 2 and resulted in an excellent therapeutic outcome. (C) 2017 by Mutaz B. Habal, MD.

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