When is acute onset concomitant esotropia a sign of serious neurological disease?

Cruysberg, J.R.M.; Draaijer, R.W.; Sellar, P W; Hoyt, Creig S.; Good, William V.

doi:10.1136/bjo.80.4.380

Cited by 10 publications

(1 citation statement)

References 6 publications

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“…5,7 In a study by Cruysberg JR. et al, neurological risk was reported to be equal in comitant and incomitant acquired esotropia. 8 Dotan G. et al suggested that neuroimaging is suggested in young patients presented with isolated sixth nerve palsy to detect intracranial tumor early. 9 Nevertheless, the decision to perform neuroimaging in patients is still complex as previous reports have provided conflicting recommendations.…”

Section: Introductionmentioning

confidence: 99%

Neuroimaging Findings in Acquired Esotropia Patients at Siriraj Hospital from 2009–2020

Surachatkumtonekul,

Khiewwan,

Hokierti

et al. 2023

Siriraj Med J

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Objective: To analyze the neuroimaging findings in patients with acquired esotropia at Siriraj Hospital from 2009 to 2020. Materials and Methods: A retrospective review of the medical records of all patients aged above 6 months old who presented with acquired esotropia was done. All the patients had an angle of deviation 10 prism diopters (PD), refraction < +3.0 diopters (D), and had neuroimaging performed. The patients with restrictive myopathy and extraocular neurological abnormalities were excluded from the study. Results: In total, 177 subjects aged between 8 months old to 81 years old (mean age 32.35 ± 24.40 years old) were included in the study. The patients’ demographic data, ocular findings, and neuroimaging findings were collected. The mean angle of deviation near and at distance were 26.88 ± 18.90 PD and 29.81 ± 17.25 PD, respectively. Of the 177 cases, 113 cases (63.8%) had no neuroimaging abnormalities, while 64 cases (36.2%) had abnormal neuroimaging findings. In those 64 cases with abnormal findings, there were 16 intracranial tumors, 6 inflammations, 4 vascular lesions, 7 degenerations, and 31 other lesions. Sixth nerve palsy was found to be significantly different between the positive and negative neuroimaging group from both the uni- and multivariate analysis. Conclusion: Although more than half of acquired esotropia patients had no abnormalities in neuroimaging, but 14.7% of those with abnormal neuroimaging findings had underlying serious conditions, which consisted of intracranial tumors, inflammation, and vascular lesions. Special attention should be concentrated to patients with sixth nerve palsy as it was the significant factor found to be associated with positive neuroimaging findings in acquired esotropia.

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