Late onset esotropia as first symptom of a cerebellar tumor

The authors present a case with a presumed neurologic cause of late onset esotropia. The first symptom was sudden occurrence of esotropia at the age of 3 3/4 years. An accommodative esotropia could be ruled out after the prescription of glasses. The squint angle showed significant variations at distance and near fixation. Eight months after the first examination intense headache appeared. The neuroophthalmologic examination and organic findings were inconspicuous, except for smooth pursuit which showed high latency of the abducting eye on both sides. MRI was performed and showed a 2-cm mass in the upper dorsal vermis diagnosed as pilocyte astrocytoma grade 1. After neurosurgery, the esotropia showed no tendency towards reduction. Four months later, a Faden operation was performed on the internal recti of both eyes, resulting in micro-esotropia. Immediately after eye muscle surgery only the Bagolini-test was positive. Currently, the patient is able to recognize the rings 1-7 in the Titmus-test and the Lang I test. Esotropia with greater esodeviation at distance is described in adults with lesions of the dorsal vermis of the cerebellum. We postulate that the esotropia in our case was probably the first symptom of a cerebellar tumor.