J Korean Ophthalmol Soc.  2020 Aug;61(8):977-981. 10.3341/jkos.2020.61.8.977.

Acute Acquired Comitant Esotropia Associated with Chiari I Malformation

  • 1Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea


We report two cases of patients who were referred to our clinic with acute acquired comitant esotropia (AACE) andwere then diagnosed with a Chiari I malformation. Case summary: A 15-year-old female presented with acute diplopia for one week. She complained of headache, dizziness, andnausea one week before the onset of diplopia. The angles of esodeviation were concomitant in all directions of gaze, and no limitationin abduction was observed. Fundus photographs showed bilateral papilledema and brain magnetic resonance imagingshowed cerebellar tonsillar herniation. She was diagnosed with acute acquired comitant esotropia associated with Chiari I malformationand was referred to the Neurosurgery Department for consideration of decompression surgery. A 12-year-old malepresented with an acute onset horizontal diplopia for one week. He had a history of dizziness with syncope three months prior tohis visit. He had comitant esotropia in all directions of gaze without any limitation of ocular movement. Brain magnetic resonanceimaging showed cerebellar tonsillar herniation and he was diagnosed with acute acquired comitant esotropia associated withChiari type I malformation. He was treated with bilateral medial rectus muscle recession surgery to correct esotropia and he hadno diplopia after the surgery.
When a patient presents with AACE, especially in the presence of neurological symptoms/signs such as headache,syncope, or papilledema, a full neurological examination and prompt neuroimaging are warranted to rule out Chiari Imalformation.


Arnold-Chiari Malformation; Comitant esotropia; Esotropia; Papilledema; Syncope
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