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Risk of serious intracranial pathology in children presenting with acute acquired comitant esotropia
Elie Côté1, Y Arun Reginald1, Michael J Wan2
1Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON; Department of Ophthalmology and Vision Sciences, Hospital for Sick Children, Toronto, ON.
Insights
In children with acute acquired comitant esotropia (AACE), serious intracranial pathology is rare but possible. Neuroimaging or close monitoring is recommended for AACE patients to detect potential underlying causes.
Area of Science:
- Ophthalmology
- Pediatric Neurology
- Neuroradiology
Background:
- Acute acquired comitant esotropia (AACE) is a sudden-onset constant nonaccommodative esodeviation in children.
- The potential link between AACE and serious intracranial pathology requires investigation.
Purpose of the Study:
- To determine the risk of serious intracranial pathology in pediatric patients presenting with AACE.
- To identify risk factors associated with intracranial pathology in AACE cases.
Main Methods:
- Retrospective observational cohort study conducted at a tertiary care pediatric hospital.
- Included 107 pediatric patients diagnosed with AACE between 2000 and 2020 who underwent neuroimaging.
- Analyzed neuroimaging results to identify serious intracranial pathology, uncertain findings, and incidental findings.
Main Results:
- The majority of patients (75.7%) had normal neuroimaging.
- Incidental findings unrelated to esotropia were observed in 18.7% of cases.
- A serious intracranial pathology (cerebellar medulloblastoma) was identified in 1 patient (0.9%), and 4.7% had findings of uncertain contribution to esotropia.
Conclusions:
- A small but significant risk of serious intracranial pathology exists in pediatric patients with AACE.
- Neuroimaging or vigilant monitoring for concerning symptoms is advised for children diagnosed with AACE.
Objective:
Acute acquired comitant esotropia (AACE) is defined as a sudden-onset constant nonaccommodative esodeviation. The purpose of this study was to determine the risk of serious intracranial pathology in children presenting with AACE.
Design:
Retrospective observational cohort study.
Setting:
Tertiary care pediatric hospital.
Methods:
The study included consecutive children who met the diagnostic criteria for AACE and had neuroimaging at a tertiary care pediatric hospital between 2000 and 2020. Patients were identified by searching the radiology database for all children who underwent neuroimaging for esotropia. The primary outcome measure was the proportion of patients with serious intracranial pathology. Secondary outcomes included risk factors for finding likely causative intracranial pathology and the proportion of patients with incidental findings.
Results:
A total of 107 patients met the inclusion criteria. Most of the patients (75.7%) had normal neuroimaging. The next most common result was an incidental finding unrelated to the esotropia (18.7%). Five patients (4.7%) had findings with uncertain contribution to esotropia, including 3 cases of type I Chiari malformation. A serious intracranial pathology was found in 1 patient (0.9%) who had a cerebellar medulloblastoma.
Conclusion:
In this large series of pediatric patients with AACE who underwent neuroimaging, there was a small but nontrivial risk of serious intracranial pathology. In these patients, it is advisable either to obtain neuroimaging or to monitor closely for the development of concerning signs or symptoms.
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