Acute Acquired Concomitant Esotropia

Abstract

Acute acquired concomitant esotropia (AACE) is a rare, distinct subtype of esotropia. The purpose of this retrospective study was to describe the clinical characteristics and discuss the classification and etiology of AACE.Charts from 47 patients with AACE referred to our institute between October 2010 and November 2014 were reviewed. All participants underwent a complete medical history, ophthalmologic and orthoptic examinations, and brain and orbital imaging.Mean age at onset was 26.6 ± 12.2 years. Of the 18 cases with deviations ≤ 20 PD, 16 presented with diplopia at distance and fusion at near vision at the onset of deviation; differences between distance and near deviations were < 8 PD; all cases except one were treated with prism and diplopia resolved. Of the 29 cases with deviations > 20 PD, 5 were mild hypermetropic with age at onset between 5 and 19 years, 16 were myopic, and 8 were emmetropic with age at onset > 12 years; 24 were surgically treated and 5 cases remained under observation; all 24 cases achieved normal retinal correspondence or fusion or stereopsis on postoperative day 1 in synoptophore; in 23 cases diplopia or visual confusion resolved postoperatively. Of the 47 cases, brain and orbital imaging in 2 cases revealed a tumor in the cerebellopontine angle and 1 case involved spinocerebellar ataxia as revealed by genetic testing.AACE in this study was characterized by a sudden onset of concomitant nonaccommodative esotropia with diplopia or visual confusion at 5 years of age or older and the potential for normal binocular vision. We suggest that AACE can be divided into 2 subgroups consisting of patients with relatively small versus large angle deviations. Coexisting or underlying neurological diseases were infrequent in AACE.

Clinical characteristics and surgical outcomes of acute acquired Comitant Esotropia

“…Neurological diseases are considered to be associated with this type of strabismus. The morbidity was from 0 to 10% in previous studies of different sizes of samples [1, 2, 9, 11]. In the present study, only two patients presented with intracranial diseases (4.4%).…”

“…In the present study, 23 out of 41 myopic patients of the Bielschowsky type wore glasses. Chen et al [9] also found that most myopic patients of the Bielschowsky type wore glasses in their study and concluded that uncorrected myopia could not be the etiology of the Bielschowsky type. Thus, whether uncorrected myopia was the etiology of this subtype of AACE was not confirmed.…”

“…Although the angle was a little larger at far than at near in this study, the difference was not statistically significant. The study by Chen et al [9] on 47 patients also reported no patient belonging to the Swan type of AACE. Bielschowsky et al [8] claimed that uncorrected myopia was the etiology of AACE.…”

Clinical features of acute acquired comitant esotropia in the Chinese populations

“…Inclusion criteria were: a diagnosis of AACE (deviation in all directions of gaze differing by ≤2 prism diopters (PD) when primary deviations were ≤20 PD and by ≤5 PD when primary deviations were >20 PD [ 12 ] ); no history of ophthalmic deficits or previous strabismus; no history of systemic disease or head trauma; and no neurological diseases proved by systemic neurological examinations. The patients who had a reduction in their esotropia with hypermetropic spectacle correction were excluded.…”

“…[ 7 – 10 ] Recently, Kemmanu et al [ 11 ] reported a small case series of AACE in the Indian populations, in which 3 patients were found to have intracranial pathology. Chen et al [ 12 ] studied 47 Chinese patients and showed that AACE was characterized by the sudden onset of concomitant nonaccommodative esotropia with diplopia in children, and that these children had a potential for normal vision. It has been suggested that AACE might be the result of a serious neurological disease, but there is a lack of evidence to confirm this theory.…”