Acute-Onset Esotropia in a 2-Year-Old Boy

Frank E. Valentin, MD; Kimberly G. Yen, MDSeries Editor: David K. Coats, MD

Disclosures

April 12, 2007

Conclusion

Evaluation of acute-onset esotropia requires a high index of suspicion for neurologic disease. Neuroimaging may be indicated, although it is not always necessary. However, it is imperative that a thorough neurologic examination be performed to determine whether the cranial nerve VI palsy is indeed an isolated finding. A sixth nerve palsy is a common cause of acute-onset esotropia, and an associated abduction deficit or head turn is usually seen on examination. Children should be followed to ensure that amblyopia does not develop. In the absence of other findings, benign recurrent sixth nerve palsy should be considered.

In summary, our patient had an acute onset of a left cranial nerve VI palsy with no viral or infectious prodrome, normal neurologic exam, 4-month resolution of all symptoms, and normal neuroimaging. The most likely diagnosis for this child is noninfectious benign cranial nerve VI palsy.

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