Acute acquired comitant esotropia of childhood: a classification based on 48 children

Area of Science:

• Ophthalmology
• Pediatric Neurology
• Neuro-ophthalmology

Background:

• Acute acquired comitant esotropia (AACE) is a significant condition in pediatric ophthalmology.
• Understanding the diverse etiologies of AACE is crucial for appropriate diagnosis and management.
• Differentiating childhood AACE from adult-onset forms may reveal distinct underlying mechanisms.

Purpose of the Study:

• To identify characteristics of pediatric patients with acute acquired comitant esotropia (AACE).
• To distinguish between AACE associated with intracranial disease and AACE without it.
• To determine risk factors that may indicate the presence of intracranial pathology in pediatric AACE.

Main Methods:

• A retrospective chart review of 48 children with AACE over 13 years.
• Inclusion criteria: acute onset comitant esotropia, complete ophthalmologic, orthoptic, and neurologic exams.
• Brain imaging (CT/MRI) was performed for children with neurological signs, AACE recurrence, or significant hyperopia; others were followed clinically.

Main Results:

• Seven cause-specific types of AACE were identified, including acute accommodative (31%), decompensated monofixation syndrome/esophoria (27%), and idiopathic (19%).
• Intracranial disease accounted for 6% of cases and included hydrocephalus and gliomas; 2 of 3 affected children had no initial neurological signs.
• Significant risk factors for intracranial disease were identified: larger distance esodeviation, AACE recurrence, papilledema, and age at onset >6 years.

Conclusions:

• Seven distinct etiological categories of pediatric AACE were identified.
• Intracranial disease is an uncommon but serious cause of AACE in children, present in 6% of this series.
• Four key risk factors can guide clinicians in deciding when to pursue neuroimaging for suspected intracranial pathology in pediatric AACE.