Ann Optom Contact Lens.  2021 Mar;20(1):43-46.

The Unilateral Abducens Nerve Palsy with Small Esotropia Caused by Clival Chordoma

• Choi YA
• Seo Y
• Kim WJ

Abstract

Purpose
To report a unilateral abducens nerve palsy caused by clival chordoma presenting with small angle of esotropia.
Case summary
A 66-year-old male visited our clinic with a complain of suddenly developed horizontal diplopia for 4 days. He did not report the presence of any other systemic disease. The visual acuity was 20/40 in both eyes. There was no proptosis and abnormal lid problem in either eye. The pupils showed normal response to both light and near stimulation. Extraocular examination revealed 6 prism diopters (PD) esotropia at primary gaze without definitive abduction limitation. The esotropia increased to 12 PD at the right gaze and orthotropia at the left gaze. There were no other systemic neurologic or ocular symptoms. The brain magnetic resonance imaging revealed the mass arising from the clivus compressing the pontine area and the right abducens nerve. He was consulted to neurosurgery department for surgical treatment of mass. The removal of tumor using endoscopic endonasal transclival approach was performed. The pathologic report confirmed the chordoma. At 1 month after the surgery, there was no diplopia. He showed orthotropia at primary and both lateral gaze.
Conclusions
The small angle of esotropia can be only presenting sign of abducens nerve palsy caused by clival chordoma. The strabismus and diplopia can be improved with surgical treatment.

Keyword

Abducens nerve palsy; Chordoma; Cranial fossa