Partially Accommodative Esotropia Manifesting as Cyclic Esotropia: A Case Study

Purpose: Cyclic esotropia is a rare disease with alternating cycles of recurrent esotropia that has been reported after strabismus surgery, head trauma, and psychological stress. We report a patient who presented with accommodative esotropia that deteriorated to cyclic esotropia and was managed successfully.Case Summary: A 2-year-old girl with no previous ophthalmological or neurological illnesses presented with esotropia. The alternate prism cover test showed 16 prism diopters (PD) of esotropia during distance and near fixation, and cycloplegic refraction showed +2.00 diopters (D) right eye and +1.50 D left eye. Under the impression of accommodative esotropia, she was prescribed glasses to fully correct her cycloplegic refraction. Nine months later, her esotropia was 14 PD with hyperopic correction. Her parents also complained that she had ‘non-squinting’ and ‘squinting’ days. The history and clinical findings suggested cyclic esotropia and she was asked to start a daily diary documenting the presence or absence of her squint. This revealed that the esotropia alternated on a 24-hour cycle. With a diagnosis of cyclic esotropia, she underwent right medial rectus recession. Postoperatively, her angle of esodeviation improved to orthotropia (near and distance) and stereoacuity was restored; this was maintained at the 1-year follow-up.Conclusions: A daily diary documenting the presence or absence of squint in patients who complain of alternating esotropia, even after hyperopic correction, is important. Cyclic esotropia often responds well to surgical management.