For years, researchers have described acute acquired comitant esotropia (AACE)—a rare pediatric presentation—as a potential presentation of a larger intracranial pathology. But new research is suggesting that instances of pediatric AACE that are not accompanied by other ophthalmic or neurological abnormalities are not necessarily manifestations of intracranial pathologies after all.             

Investigators reviewed the records of 20 AACE patients with otherwise normal neurological and ophthalmological evaluations. Each patient (mean age 9.8 years) was evaluated for risk of neurological disease using brain and orbit MRI.

They found that all 20 had no signs of early ophthalmological or neurological disease; 19 had normal brain neuroimaging and the one who did not undergo imaging was followed for two years without developing any neurological sequelae.

The researchers believe that, although the sample size was small, these results confirm that isolated pediatric AACE is often benign. This can help reduce unnecessary testing for most, although neuroimaging can still be considered on a case-by-case basis.

Dotan G, Keshet Y, Qureshi H, et al. When pediatric acute acquired comitant esotropia is not caused by a neurological disease. J AAPOS. January 7, 2020. [Epub ahead of print].