Acute Onset Comitant Esotropia as initial manifestation of Arnold-Chiari Type 1 malformation in Children-A Case report and Review

We report a case of 5 year old girl who presented with acute onset of Comitant esotropia in right eye with no neurological signs and symptoms. Cycloplegic refraction revealed emmetropia. Her anterior and posterior segments were with in normal limits. Her general physical and neurological examination were normal.MRI Brain revealed Arnold Chiari Type I malformation. Child was referred to Neurosurgeon for further management. Neurosurgeon advised Nil surgical intervention at present. She was advised and underwent Strabismus surgery in Right eye for esotropia to revert the foveal suppression and to regain the stereopsis . The exact mechanism for acute onset esotropia is not known. The casual relationship of acute onset esotropia in Arnold chiari type 1 malformation is very rare. Neuroimaging should be done in case of acute onset esotropia to rule out Intracranial pathology. It is important to remember that acute onset comitant esotropia in the absence of other neurologic signs and symptoms in infancy or childhood may be the first sign of an underlying Arnold Chiari type 1 malformation.