See-saw nystagmus after strabismus surgery

A 7-year-old child underwent craniotomy for a craniopharyngioma. One month later she developed a divergence excess type exotropia and had strabismus surgery 11 months later. The day after strabismus surgery, the parents noted abnormal eye movements that represented see-saw nystagmus. The patient had a small esotropia after surgery, but it was found that stimulated convergence controlled the nystagmus. This case illustrates the dual central and ocular influence on the development of see-saw nystagmus.