Acute Reversible Convergent Strabismus Following Accidental Lorazepam Ingestion in a Child: A Rare Ocular Manifestation of Benzodiazepine Toxicity

Abstract

Benzodiazepine intoxication in children commonly manifests with central nervous system depression, hypotonia, and ataxia. Ocular motor abnormalities are uncommon and may mimic serious neurological disorders, frequently prompting urgent neuroimaging. We report the case of an eight-year-old boy who presented with sudden-onset convergent strabismus approximately 30 minutes after accidental ingestion of 10 mg of lorazepam. On admission, he was hemodynamically stable with a Glasgow Coma Scale score of 15/15. Neurological examination was unremarkable except for acute esotropia. Brain computed tomography revealed no abnormalities, and urine toxicology screening was positive for benzodiazepines. The patient was managed conservatively with close clinical observation without administration of flumazenil. Complete spontaneous resolution of the ocular deviation occurred within 12 hours. This case highlights that isolated acute strabismus may represent a rare but reversible manifestation of benzodiazepine intoxication in children. Awareness of this presentation may help clinicians consider toxicological causes in the differential diagnosis and avoid unnecessary invasive investigations.