Publication: Acute acquired comitant esotropia: Etiology, clinical course, and management
Issued Date
2021-01-01
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ISSN
11775483
11775467
11775467
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2-s2.0-85104983342
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Mahidol University
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SCOPUS
Bibliographic Citation
Clinical Ophthalmology. Vol.15, (2021), 1567-1572
Suggested Citation
Apatsa Lekskul, Nichaboon Chotkajornkiat, Wadakarn Wuthisiri, Phantaraporn Tangtammaruk Acute acquired comitant esotropia: Etiology, clinical course, and management. Clinical Ophthalmology. Vol.15, (2021), 1567-1572. doi:10.2147/OPTH.S307951 Retrieved from: https://repository.li.mahidol.ac.th/handle/123456789/78760
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Title
Acute acquired comitant esotropia: Etiology, clinical course, and management
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Abstract
Purpose: To identify the etiologies, clinical course and management of acute acquired comitant esotropia in Ramathibodi Hospital, Thailand. Methods: Thirty patients who were diagnosed with acute acquired comitant esotropia at Ramathibodi Hospital from January 1 2017 to December 31 2019 were identified using electronic medical records, from which demographic, etiology, clinical course and management, laboratory, and neuroimaging data were collected. Results: The etiologies of acute acquired comitant esotropia were Swan (16.67%), Burian– Franceschetti (30.00%), Bielschowsky (36.67%), Arnold Chiari malformation (3.33%) and decompensated esophoria (13.33%). Mean age of onset was 19.8 ± 18.3 years. Mean angle of esodeviation was 28.4 ± 12.1 prism diopters for distance fixation and 29.3 ± 11.8 prism diopters for near fixation. Refraction differed between age groups: children under 10 years had mild hyperopia (median +0.63 diopters, first quartile +0.25 diopters, third quartile +0.75 diopters) and teenagers (10–18 years old) had emmetropia to mild myopia (median +0.25 diopters, first quartile −2.50 diopters, third quartile +0.75 diopters), whereas adults had mild to moderate myopia (median −0.75 diopters, first quartile −5.25 diopters, third quartile ±0.00 diopters). Twelve patients (40.00%) were prescribed spectacles and surgical intervention was performed in 26 patients (86.67%). All patients except one case of Arnold Chiari malformation (96.67%) maintained normal binocular function and alignment following strabismus surgery or spectacles correction. Conclusion: Bielschowsky was the most common etiology of acute acquired comitant esotropia in our study. We suggest that refraction should be performed in all patients with acute acquired comitant esotropia. Most etiologies were benign and might not require neuroimaging. However, neuroimaging is recommended in those with atypical presentations, such as nystagmus, headache, or cerebellar signs. Surgical intervention with a 0.5–1.0 mm increase in recession was effective for restoring ocular alignment and binocular function in our patients.