gms | German Medical Science

102. Jahrestagung der DOG

Deutsche Ophthalmologische Gesellschaft e. V.

23. bis 26.09.2004, Berlin

Cyclic strabismus with pain after strabismus surgery

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  • corresponding author P. Charbel Issa - Augenklinik der Julius-Maximillians-Universität, Würzburg
  • H. Steffen - Augenklinik der Julius-Maximillians-Universität, Würzburg

Evidenzbasierte Medizin - Anspruch und Wirklichkeit. 102. Jahrestagung der Deutschen Ophthalmologischen Gesellschaft. Berlin, 23.-26.09.2004. Düsseldorf, Köln: German Medical Science; 2004. Doc04dogP 117

The electronic version of this article is the complete one and can be found online at:

Published: September 22, 2004

© 2004 Charbel Issa et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.




We describe a rare case of a periodic and painfull strabismus after strabismus surgery.

Case report

A 26-year-old male patient presented with a convergent strabismus and a hypotropia of the right eye. The patient reported the symptoms, which could be triggered by visual strain, as occurring every 2-3 days, mainly in the evenings. The misalignment of the eyes persisted for several hours and was accompanied by a dull pain in the medial canthus. The symptoms have been present since an operation carried out three years previously to correct a secondary divergent strabismus with hypertropia. Twelve years earlier, the patient suffered a severe ocular trauma on the right with hemorrhagia, traumatic cataract and choroid rupture. A cataract operation and vitrectomy were carried out. In the orthoptic examination, a slight hypertropia of the right eye with a marginal abduction deficit was present in the pain free interval. While in pain, there was a convergent squint with hypotropia. The right pseudophakic eye with a visual acuity of 1/35 and an intraocular pressure up to 35 mmHg without correlation to pain showed a glaucomatous visual field defect. The eye with a traumatised anterior segment had an optic nerve head typical for glaucoma and a choroid scar in the macular area. There was no abnormality detected in the left eye. The orbital ultrasound and CT-scan as well as the neurological examination were all inconspicuous. The secondary glaucoma could be controlled by medical therapy. Due to the suspected neuropathic origin of the persistent squint- and pain, therapy with gabapentin was started. This treatment largely alleviated the symptoms.


The precise origin of the regularly appearing squint stages in conjunction with pain remains unclear. An ischemic pain onset due to a neuropathic constant muscular contraction seems possible. The latter could emerge after primary damage to efferent fibres or by a central sprouting after damage of afferent fibres with a secondary efferent hyperexcitability. The hypothesis is supported by the effectiveness of gabapentin.