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Acute comitant esotropia in a child with a cerebellar tumor

Jong-Min Lee1, Sin-Hoo Kim, Jeong-Il Lee

  • 1Department of Ophthalmology, College of Medicine, Catholic University of Daegu, Daegu, Korea.

Korean Journal of Ophthalmology : KJO
|October 2, 2009
PubMed

Insights

Acute acquired comitant esotropia in a child may signal a cerebellar tumor, even without other neurological symptoms. Early detection of this pediatric eye condition is crucial for timely diagnosis and treatment.

Area of Science:

  • Pediatric Ophthalmology
  • Pediatric Neurology
  • Neuro-oncology

Background:

  • Acute acquired comitant esotropia (AACE) is a rare condition in children.
  • Cerebellar tumors can present with varied neurological signs, but ophthalmological manifestations are not always prominent.

Observation:

  • A 3-year-old boy presented with a 9-month history of AACE, measuring 50 prism diopters.
  • Fundus examination revealed mild bilateral papilledema; neurological exam was otherwise normal.
  • Brain MRI identified a midline cerebellar mass and hydrocephalus.

Findings:

  • The cerebellar mass was diagnosed as a pilocytic astrocytoma and surgically excised.
  • Post-surgery, the esotropia persisted, requiring strabismus surgery (medial rectus recession).
  • Despite surgical intervention, bifoveal fusion was not restored, indicating persistent strabismus.

Implications:

  • AACE in children can be an initial presenting sign of an underlying cerebellar tumor.
  • This case highlights the importance of a thorough neurological and neuroimaging workup for pediatric AACE.
  • Ophthalmologists should consider central nervous system pathology in the differential diagnosis of AACE.

Keywords:
Acute onsetCerebellar tumorComitant esotropia

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