Abstract
This is a unique case of bilateral asymmetrical cyclic oculomotor palsy with spasm (COPS). This is an unusual presentation of COPS, which is usually unilateral. The patient initially presented with cyclic upper lid ptosis, exotropia, hypotropia, and mydriasis, lasting approximately 1.5 minutes. The affected eye would then recover, and the other eye would undergo the same pattern of symptoms in keeping with COPS. The right eye has shown spontaneous improvement of symptoms over the 7 years of follow-up. The use of ptosis surgery, together with patching, seems to have been able to prevent the development of amblyopia in the left, worse-affected eye.
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