Treatment of acute comitant esotropia in Chiari I malformation

PURPOSE: To explore the appropriate treatment of acute comitant esotropia in patients with Chiari I malformation. DESIGN: Interventional case reports and literature review. PARTICIPANTS: Two patients with Chiari I malformation presenting with acute comitant esotropia are described. INTERVENTION: Strabismus surgery, then neurosurgical decompression of the Chiari I malformation was performed. MAIN OUTCOME MEASURE: Both patients were evaluated for resolution of esotropia and other ocular motility problems. RESULTS: After initially successful strabismus surgery, both patients developed recurrent esotropia with diplopia, which resolved on suboccipital decompression. CONCLUSION: Comitant esotropia may recur and other eye movement disorders may develop after initially successful strabismus surgery in patients with Chiari I malformation. The data suggest that the appropriate sequence of treatment should first be suboccipital decompression, then strabismus surgery if spontaneous realignment does not occur, but further studies are needed to confirm this impression.