We encountered a 5-year-old girl with acute onset of alternating, comitant esotropia in the absence of diplopia and other neurologic findings. She did not have any refractive error and seen bilateral papilledemas in fundus examination, magnetic resonance imaging (MRI) of the head was performed. A large cerebellar astrocytoma and moderate hydrocephalus was identified and successfully resected. The onset of comitant esotropia in a child can be the first sign of a cerebellar tumor without any other neurologic signs and symptoms.
Background: Congenital esotropia has a deviation of 50 or more prism diopters (Δ). Generally, surgical alignment of the eyes is the accepted treatment but surgical techniques differ. Methods: A total of 54 patients were evaluated. Surgery was done at a mean age of 28 months. Bimedial rectus recessions up to 8 mm were performed. Results: The mean preoperative deviation was 70 Δ of esotropia. Our success rate with a uniform approach was 66.6%. Conclusions: Contrary to the selective approach for large angle congenital esotropia, we do not consider initial surgery on three or more muscles. Our method is quicker, simpler, less traumatic, and leaves the lateral rectus muscles unoperated for patients requiring a second surgery. Journal of Pediatric Ophthalmology and Strabismus 1999;36:201-205.
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