Acute Comitant Esotropia
Abstract
<h4>EXCERPT</h4> <p><b>Wagner</b>: A 4-year-old boy had an acute onset of a right esotropia and double vision for 1 day. He had good ophthalmologic care previously for a right nasolacrimal duct obstruction that required intubation approximately 8 months earlier. I don’t think this is related, but 2 weeks prior to presentation he arrived at the emergency department with a silicone tube out on his cheek, which was then removed.</p> <p>At presentation, he did not appear distressed, although he closed his right eye frequently. He was afebrile. He had no history of recent viral illnesses. Visual acuity was 20/30 in each eye. There was no afferent pupillary defect. He had a right esotropia of 25 PD at distance and near that seemed to be comitant. Nothing else could be seen in full ocular motility. No signs of an abduction deficit were seen in either eye. Cycloplegic retinoscopy results were +2.50 in each eye. The dilated retinal examination revealed blurred optic disk margins in both eyes. I wouldn’t say it was frank papilledema, but it was abnormal. Results of his recent eye examination 2 or 3 months prior were normal.</p> <p>This 4-year-old boy, who looks good and plays well, is closing his right eye with measurable strabismus and the early findings of papilledema. What is a working diagnosis, and what would be your next step?</p> <p><b>Lueder</b>: I would presume that he had increased intracranial pressure. The results of his previous examination were normal. His vision was normal, and now he is presenting with strabismus. This is not a child with an acute esotropia who is otherwise fine neurologically. I’d be looking at something intracranial and trying to determine if a mass is present.</p>
