Cyclic (alternate day) vertical deviation--possible forme fruste of ocular neuromyotonia

Journal of AAPOS : the Official Publication of the American Association for Pediatric Ophthalmology and Strabismus
Gill Roper-HallSophia M Chung

Abstract

Cyclic ocular deviations are relatively uncommon and are seldom seen in adults. We report 3 adult patients with cyclic hypotropia that has clinical characteristics similar to neuromyotonia, suggesting a possible common etiology. Three consecutive patients with 48-hour cyclic hypotropia underwent full neuro-ophthalmologic, oculoplastics, and orthoptic evaluations as well as appropriate medical and neurologic studies. Examinations were arranged on consecutive days on multiple visits to document the cyclic pattern. All 3 patients had sustained contraction of a vertically acting extraocular muscle lasting 24 hours and demonstrated characteristics of ocular neuromyotonia. The contraction was absent for the next 24 hours. Two of the patients had thyroid eye disease; the third patient had unilateral ophthalmoparesis and had subsequent frameless robotic radiosurgery for a cavernous sinus schwannoma. Regular cycles lasting 6, 9, or 14 months were documented by all 3 patients. In 2 patients, treatment with carbamazepine and gabapentin effectively reduced or eliminated the cycle. The cyclic deviation in the third patient resolved spontaneously. On the basis of the response of these patients to membrane-stabilizing medications and the beha...Continue Reading

References

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Citations

Jun 11, 2015·Journal of AAPOS : the Official Publication of the American Association for Pediatric Ophthalmology and Strabismus·Cheryl S NgoStephen P Kraft
Jul 28, 2016·BMC Ophthalmology·Ji-Sun PaikShin Hae Park
Oct 26, 2018·Journal of Binocular Vision and Ocular Motility·Carlos Souza-DiasLuiz Eduardo Rebouças de Carvalho
Feb 27, 2019·Journal of Binocular Vision and Ocular Motility·Barrett ThompsonAmy McGregor
May 23, 2019·Journal of Pediatric Ophthalmology and Strabismus·Kimberly MerrillRaymond G Areaux
Mar 30, 2016·Journal of Neuro-ophthalmology : the Official Journal of the North American Neuro-Ophthalmology Society·J Anna KimStacy L Pineles

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