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

Gill Roper-Hall; Oscar A Cruz; Gabriela M Espinoza; Sophia M Chung

doi:10.1016/j.jaapos.2012.12.156

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

Journal article

Peer reviewed

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

Gill Roper-Hall, Oscar A Cruz, Gabriela M Espinoza and Sophia M Chung

Journal of AAPOS, Vol.17(3), pp.248-252

06/2013

DOI: 10.1016/j.jaapos.2012.12.156

PMID: 23791405

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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 behavior noted as the cycle broke each day, we propose that cyclic vertical strabismus and ocular neuromyotonia may be related conditions with similar underlying physiology.

Humans

Isaacs Syndrome - diagnosis

Isaacs Syndrome - therapy

Middle Aged

Periodicity

Strabismus - diagnosis

Carbamazepine - therapeutic use

Male

Diplopia - therapy

Exophthalmos - therapy

Oculomotor Muscles - pathology

Exophthalmos - diagnosis

Ophthalmologic Surgical Procedures

Visual Fields

Female

Strabismus - therapy

Diplopia - diagnosis

Details

Title: Subtitle: Cyclic (alternate day) vertical deviation--possible forme fruste of ocular neuromyotonia
Creators: Gill Roper-Hall - Department of Ophthalmology, Saint Louis University Medical Center, St Louis, Missouri, USA. grh@slu.edu
Oscar A Cruz
Gabriela M Espinoza
Sophia M Chung
Resource Type: Journal article
Publication Details: Journal of AAPOS, Vol.17(3), pp.248-252
DOI: 10.1016/j.jaapos.2012.12.156
PMID: 23791405
NLM abbreviation: J AAPOS
ISSN: 1091-8531
eISSN: 1528-3933
Publisher: Elsevier Inc
Language: English
Date published: 06/2013
Academic Unit: Neurology; Ophthalmology and Visual Sciences
Record Identifier: 9984111973202771

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