A 6-month-old patient with Apert syndrome underwent strabismus surgery for a hypertropic eye. At surgery, the patient was found to have agenesis of all four cyclovertical muscles in one eye. Further investigation by computed tomography demonstrated absence of all four cyclovertical muscles in the fellow eye as well. A transposition procedure corrected the strabismus. While isolated aberrant or missing extraocular muscles are well documented in patients with craniofacial syndromes, bilateral absence of all four cyclovertical muscles, as demonstrated in this patient, poses unique treatment challenges.
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