Cyclic Vertical Deviation after Ocular Myositis
Bau V.1, Weidlich R.1, Duncker G. I. W.1, Zierz S.2
1Dept. of Ophthalmology, 2Dept. of Neurology, University of Halle/Saale
Purpose: Cyclic convergent strabism is a rare disorder. It may occurs spontaneously, upon squint surgery or in association with leasions of the central nervous system. In most cases the deviations are horizontally. A vertical deviation was only reported in one case following craniofacial surgery for fronto-orbital fibrous dysplasia.
Method: Case report
Results: A 34-years old woman developed a bilateral recurrent ocular myositis during pregnancy. Two-year-therapy included prednisolon, methotrexat and immunoglobulins. Residual symptoms were mild symmetric motility disorders but no strabism. Upon clinical remission of the myositis cyclic vertical deviation became manifest. Following a 48-h rhythm hypotropia of the left eye with accompanying diplopia alternated with days of orthotropia without squint. Four months after recession of the inferior rectus mucle the alternating squint disappeared.
Conclusions: The aetiology of cyclic eye deviations and of the mostly 48-hours rhythm is not known. The association with leasions of the central nervous system indicates a primary central dysregulation of a "biological clock". The well known occurrence, however, upon squint surgery and as in the present case upon orbital myositis suggests, that also primarily peripheral movement abnormalities may lead to a central dysregulation. Thera
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