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Adult-Onset Cyclic Esotropia: A Case Report

Di Meo, Antonio*; Costagliola, Ciro*; Della Corte, Michele*; Romano, Antonio*; Foria, Consuelo; Di Costanzo, Alfonso*

doi: 10.1097/OPX.0b013e31828159bf

Purpose: This case report presents the diagnosis and management of an adult patient with cyclic esotropia, a rare and poorly understood form of strabismus, that is characterized by alternating periods of manifest strabismus and orthotropia. Few cases of adult-onset cyclic strabismus have been reported. The etiology, pathogenesis, and treatment for this condition are reviewed.

Case Report: A 37-year-old man with high unilateral myopia and anisometropic amblyopia in his left eye developed cyclic esotropia 2 months after a scleral buckle procedure for a retinal detachment. A 48-hour cycle that consisted of a 24-hour period of orthotropia followed by a 24-hour period of constant left esotropia was present. Magnetic resonance imaging, electromyography, electroencephalography, and ocular and orbital echography were unremarkable, as was a neurological assessment that included fatigue and edrophonium testing. The patient was successfully managed with muscle surgery.

Conclusions: The etiology and pathogenesis of adult-onset cyclic esotropia remain unknown. Cyclic esotropia should be considered in the differential diagnosis when an individual presents with a history of intermittent strabismus that is present some days and not others.



Clinica Oculistica, Seconda Università degli Studi di Napoli, Napoli, Italy (ADM, MDC, AR, CF); and Dipartimento di Medicina e Scienze per la Salute, Università degli Studi del Molise, Campobasso, Italy (CC, ADC).

Ciro Costagliola Department of Medicine and Health Sciences University of Molise via F. de Sanctis s.n.c. 86100 Campobasso Italy e-mail:

© 2013 American Academy of Optometry