Acquired Concomitant Esotropia in Pseudotumor Cerebri

Abstract

Acquired esotropia due to increased intracranial pressure is classically associated with unilateral or bilateral 6th nerve palsy and/or divergence paralysis. We have recently treated a 17 year old black girl with pseudotumor cerebri (benign intracranial hypertension) presenting with headaches, horizontal diplopia, and papilledema. Motility evaluation revealed a concomitant, moderate angle esotropia greater at near, with normal retinal correspondence and good fusional amplitudes. Horizontal saccadic velocities were normal in both eyes, arguing against the presence of 6th cranial nerve palsy. The strabismus resolved following normalization of her intracranial pressure. Acute-onset esotropia may be the presenting sign of increased intracranial pressure in the absence of clinically evident 6th nerve palsy or divergence paralysis.

• benign intracranial hypertension
• divergence paralysis
• esotropia
• pseudotumor cerebri
• sixth nerve palsy