Purpose: To report a case of acute comitant esotropia successfully treated with suboccipital decompression in a 9-year-old male patient with Chiari I malformation.
Design: Interventional case report.
Methods: A 9-year-old male with Chiari I malformation had acute onset of diplopia, headache, and comitant esotropia.
Results: About 9 months after suboccipital decompression, diplopia resolved and there was near orthophoria on examination 15 months after surgery.
Conclusion: In view of our case and after a review of literature, we advocate primary suboccipital decompression to treat acute comitant esotropia in patients with Chiari I malformation. A follow-up period of at least 1 year rather than 6 months seems necessary to assess surgery effects.