Treatment of acute comitant esotropia in Chiari I malformation

Purpose: To explore the appropriate treatment of acute comitant esotropia i n 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 C hiari I malformation was performed. Main Outcome Measure: Both patients were evaluated for resolution of esotro pia and other ocular motility problems. Results: After initially successful strabismus surgery, both patients devel oped recurrent esotropia with diplopia, which resolved on suboccipital deco mpression. Conclusion: Comitant esotropia may recur and other eye movement disorders m ay develop after initially successful strabismus surgery in patients with C hiari I malformation. The data suggest that the appropriate sequence of tre atment should first be suboccipital decompression, then strabismus surgery if spontaneous realignment does not occur, but further studies are needed t o confirm this impression.