Aim: To describe a case of multiple sclerosis which presented with sudden-onset esotropia.
Method: A case is documented with history, ophthalmic and neurological findings and management. Multiple sclerosis is discussed in relation to paediatric onset.
Results: A previously healthy boy aged 2 years 10 months presented with malaise, fever and sudden-onset right esotropia, which followed a urinary tract infection 4 weeks earlier. Ophthalmic examination revealed bilateral papilloedema. Magnetic resonance imaging (MRI) showed multiple areas or high signal in the basal ganglia and subcortical white matter in the occipital and right frontal lobes. Steroid medication was commenced and resulted in a reduction in signs and symptoms. The provisional diagnosis was acute demyelinating encephalomyelitis (ADKM). Following two further similar episodes a diagnosis of multiple sclerosis was made based on the variation or neurological signs and resolving demyelination on MRI brain scans.
Conclusion: Multiple sclerosis is very rare in childhood. This was not u typical case of esotropia in a 2-year-old child, as the presence of bilateral papilloedema was indicative of urgent investigation.