Poster 29

by in  Poster Session 1

Cyclic Esotropia: White Matter Changes on MRI and Surgical Outcomes

Kimberly Merrill, CO; Raymond Areaux, MD; Jill Anderson, MD; Daniel Watson, MD
University of Minnesota
Minneapolis, MN

 

Introduction: Cyclic esotropia (CET) was first described in 1845. It occurs most frequently in children 2-6 years old. Patients present with alternating periods of orthophoria and esotropia, no amblyopia, insignificant refractive error, and a normal anatomical eye exam. We report five cases of CET who presented within ten months. Given the high incidence in a short period, we reviewed their charts to further characterize the disorder and review treatment outcomes.

Methods: Retrospective case series: History of onset, ocular exam, motility exam, MRI, labs, calendars documenting phases, surgical treatments, postoperative alignment, and fusion were reviewed.

Results: All patients had normal labs. MRI was abnormal in 2 of 5 cases. Both manifested abnormal white matter signal in the frontal lobes. 3 of 5 patients complained of diplopia, irritability, or distress when tropic. Typical periodicity followed a 48-hour cycle. Cyclic phase varied from 1 to 9 weeks. The average maximum deviation was 35^ ET. Bimedial rectus recessions for the maximum measured angle of esotropia was successful in all 5 patients. One patient required a re-operation. Fusion was present in 4 patients preoperatively and in all 5 patients postoperatively.

Discussion: All patients had normal labs. MRI was abnormal in 2 of 5 cases. Both manifested abnormal white matter signal in the frontal lobes. 3 of 5 patients complained of diplopia, irritability, or distress when tropic. Typical periodicity followed a 48-hour cycle. Cyclic phase varied from 1 to 9 weeks. The average maximum deviation was 35^ ET. Bimedial rectus recessions for the maximum measured angle of esotropia was successful in all 5 patients. One patient required a re-operation. Fusion was present in 4 patients preoperatively and in all 5 patients postoperatively.

Conclusion: We are unsure what caused this streak of CET in our practice. MRI with attention to frontal lobe white matter should be considered in the work-up of CET. Bimedial rectus recessions successfully restored fusion in our cases.

References: 1.Hamed LM, Silbiger J. Periodic alternating esotropia. J Pediatr Ophthalmol Strabismus 1992;29(4):240-2.
2.Metz HS, Bigelow C. Change in the cycle of circadian strabismus. Am J  Ophthalmol 1995;120(1):124-5.
3.Roper-Hall MJ, Yapp J. Alternate day squint. The First International Congress of Orthoptics. St. Louis: CVMosby Co; 1968. p. 262

Print Friendly, PDF & Email

Leave a Comment

Your email address will not be published. Required fields are marked *

Comment *