Horizontal gaze palsy with ipsilateral esotropia with substituted convergence in a child with medulloblastoma

Introduction: Horizontal Gaze palsy with concurrent esotropia and substituted convergence is a rare clinical presentation. Methods: We report a case of a 6-year-old child being treated for pontine medulloblastoma who presented with bilateral abducens and bilateral facial nerve palsy. The patient progressed to develop right sided horizontal gaze palsy with bilateral abducens palsy and substituted convergence. In view of limited abduction in his right eye, a modified Nishida procedure was performed followed by botulinum toxin to the right medial rectus both of which failed in improving the ocular alignment. Subsequently, the patient underwent an asymmetric, bilateral recess-resect procedure. Results: The recess-resect procedure resulted in a correction of his compensatory face turn and ocular deviation with orthotropia in primary position and binocular single vision. Conclusion: This case report reiterates the importance of asymmetric recess-resect surgery rather than vertical rectus transposition surgery in such a case.