Periodic unilateral eyelid retraction in a pediatric patient

Area of Science:

• Ophthalmology
• Neurology
• Anesthesiology

Background:

• Congenital eyelid retraction is a common condition affecting eyelid position.
• Cyclic oculomotor palsy is a rare neurological disorder characterized by periodic eye movement abnormalities.

Observation:

• An 11-year-old girl with congenital right upper eyelid retraction developed periodic, cyclic spasms of the affected eyelid during general anesthesia.
• These spasms occurred precisely every 48 seconds, causing rapid eyelid elevation without affecting pupil size or eye position.
• The contralateral eyelid remained unaffected, and no underlying neurological or thyroid abnormalities were identified.

Findings:

• The patient underwent successful levator recession surgery for the eyelid malposition.
• Postoperative evaluation revealed no recurrence of cyclic eyelid spasms or other oculomotor abnormalities in the waking state.
• This case highlights an unusual presentation of congenital eyelid retraction with intraoperative cyclic spasms, distinct from typical cyclic oculomotor palsy.

Implications:

• This unique case expands the spectrum of congenital eyelid retraction presentations.
• It suggests potential anesthetic-induced neurological phenomena that can mimic or coexist with pre-existing conditions.
• Further investigation may be warranted to understand the mechanisms underlying such intraoperative cyclic eyelid spasms.