Frontalis sling surgery: A treatment modality for cyclic oculomotor nerve palsy

Cyclic oculomotor nerve paresis and spasm are a rare disorder characterized by alternating spastic and paretic phase of the muscles supplied by the oculomotor nerve. A 26-year-old male presented with abnormal right eyelid movements since early childhood. Examination findings were consistent with diagnosis of right eye cyclic oculomotor nerve palsy. A paretic phase with complete upper eyelid ptosis, exotropia, hypotropia and dilatation of the pupil was followed by a phase of orthotropia, the absence of ptosis and normal pupil size. The whole cycle was of about 100 s duration with patient having no voluntary control over the eyelid movements and ocular alignment. Systemic evaluation and neuroimaging were normal. A tarsofrontal silicone sling surgery done for the ptosis correction decreased the eyelid movements during different phases of the cycle.