Consecutive cyclic exotropia after surgery for adult-onset cyclic esotropia

Cyclic esotropia--periods of esotropia alternating with periods of orthotropia, most commonly on a 48-hour cycle--is a rare condition seen mostly in children. Surgical correction of the maximum deviation generally corrects the esotropia without resulting in alternating periods of exotropia, as might be expected if the periodicity continued postoperatively. Unlike cyclic esotropia in children, the few reported adult cases have often been associated with severe acquired monocular visual impairment; however, the response to surgical treatment is reported to be the same as that in children. We report here an exception, in which an adult patient developed cyclic exotropia after surgical correction of her acquired cyclic esotropia.