Oculomotor Paresis with Cyclic Spasm: A Case Report

A 12-year-old girl presented with left upper eyelid ptosis, who experienced intermittent lid contractions since birth. We noted regular cyclic movements of the upper eyelid, eyeball, and pupil. The cycle comprised periods of ptosis, exotropia, and mydriasis alternating with symmetrical eyelid position, ocular alignment, and pupillary size. The interpalpebral fissure measured 4 mm in the paralytic phase and 10 mm in the spastic phase. The pupil diameter, which was 6 mm, contracted to 3 mm in the spastic phase. These spasms last about 20 seconds. Three cycles were observed in 10 minutes. The upward gaze was slightly impaired in the paretic phase but cyclic movement in the vertical direction was not observed. The affected eye was amblyopic. The patient had voluntary control over his paretic phase when doing a close visual task. She was followed up for two years without any change.