Management of idiopathic intracranial hypertension in an infant with bilateral congenital cataract and associated comitant sensory esotropia

Abstract

In this report, we describe the management of a child with bilateral cataract, nystagmus, and comitant sensory esotropia. Routine ultrasonography done before cataract surgery revealed bilateral disc edema confirmed as idiopathic intracranial hypertension by a pediatric neurologist. The primary intervention for cataract surgery was followed by nonresolving papilledema, despite maximum medical therapy. To salvage the optic nerve function in a nonverbal child, bilateral optic nerve sheath decompression was planned with simultaneous medial rectus recessions for the persistent esotropia with the satisfactory postoperative outcome.

Figure 1

Clinical photograph of child; (a) preoperatively showing right esotropia with psuedophakia in both eyes, (b) postoperatively, photograph showing orthotropia and pseudophakia in both eyes

Figure 2

B-scan right (left image) and left eye (right image); (a) at presentation showing optic nerve head (thick arrow) with size of 5 mm in right eye and 5.30 mm in left eye and an echolucent crescent due to the sub-arachnoid fluid around the optic nerve (thin arrow), intraoperative image showing, (b) distended optic nerve sheath (arrowhead) and short posterior ciliary vessels (thin arrow) over optic nerve, (c) B-scan right (left image) and left eye (right image); postoptic nerve sheath decompression showing decrease in optic nerve head size (thick arrow) with resolution of sub-arachnoid fluid around optic nerve

Figure 3

Magnetic resonance imaging of brain (T2 sagittal scan) showing distended optic nerve sheaths indicated by white arrows in both eyes