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Accommodative esotropia: an unrecognized cause of hemifacial spasm in children
1University of Arkansas for Medical Sciences, Little Rock 72202, USA.
Insights
Pediatric hemifacial spasm may indicate an intracranial tumor. However, this study suggests accommodative esotropia is a potential cause in children, presenting as an early sign of vision issues.
Area of Science:
- Ophthalmology
- Pediatric Neurology
Background:
- Hemifacial spasm in children can be associated with serious neurological conditions like intracranial tumors.
- Early identification of the underlying cause is crucial for timely intervention and management.
Observation:
- Two young female patients presented with hemifacial spasm.
- Initial examinations revealed high hyperopia but no apparent esotropia.
- Esotropia developed within a month in both cases.
Findings:
- Hemifacial spasm in both patients was linked to accommodative esotropia.
- Squinting to manage diplopia resulted in overflow facial movements mimicking hemifacial spasm.
- Spasms resolved with spectacle correction in one child and with amblyopia onset in the other.
Implications:
- Accommodative esotropia should be considered in the differential diagnosis of pediatric hemifacial spasm.
- This finding broadens the diagnostic scope for pediatric hemifacial spasm beyond intracranial pathologies.
- Highlights the importance of comprehensive ophthalmologic evaluation in pediatric cases.
Abstract:
Pediatric hemifacial spasm can be a sign of an intracranial tumor. We examined two females, ages 2 and 6 years, who presented with hemifacial spasm as an early sign of accommodative esotropia. Initial ophthalmologic examination disclosed high hyperopia without detectable esotropia. Both children developed an intermittent esotropia over the following month. In the first child, the hemifacial spasm resolved concurrent with the onset of amblyopia. In the second child, spectacle correction produced immediate cessation of the spasms. In both children, squinting to avoid diplopia produced an overflow facial movement that manifested as hemifacial spasm. Accommodative esotropia should be considered in the differential diagnosis of pediatric hemifacial spasm.
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