Acute Adult Onset Comitant Esotropia Associated with Accommodative Spasm

Abstract

Acute adult onset esotropia occurring with accommodative spasm responds favorably to cycloplegic medications but may need a longer course of treatment for successful resolution and stability.

Unusual Presentation of Spasm of Near Reflex Mimicking Large-Angle Acute Acquired Comitant Esotropia

“…This task may be further hampered by the dark pigmentation of the iris. 2,5 AACE is an uncommon presentation of strabismus in older children and adults. 4 Three main types have been described.…”

“…5 Their patient had a functional aetiology and developed the convergence spasm after wearing overcorrected glasses of À5.00 DS. Similar to our case, they have also noted persistence of esotropia despite cycloplegic therapy.…”

Atypical presentation of acute acquired comitant esotropia

“…Over a six‐year period, the spherical equivalent refraction in the right eye changed from −0.25 to −3.50 D, whereas in the left eye it changed from −12.00 D to −10.62 D. A myopic shift occurred unilaterally in the less ametropic eye. At the onset of acute acquired comitant esotropia and during numerous follow‐up visits, both dynamic and static retinoscopy in the right eye fluctuated considerably, possibly indicating a superimposed accommodative spasm; however, unilateral accommodative spasm is extremely uncommon . Also, pupillary miosis was not observed and all refractions were performed using cycloplegia.…”

“…Although frequently idiopathic, acute acquired comitant esotropia can be caused by interruption of binocular vision due to prolonged monocular eye lid closure or occlusive treatment for anisometropic amblyopia, decompensation of pre‐existing esophoria or small‐angle esotropia, loss of vision in one eye secondary to injury or disease, mild to moderate uncorrected myopia in adults, accommodative spasm and intracranial pathology . The last may present with additional signs and symptoms, such as abducting nystagmus, papilloedema, headaches, unsteadiness, as well as inability to achieve fusion with corrective prisms or the synoptophore .…”

“…Differential diagnosis for acute acquired comitant esotropia includes incomitant esotropia due to lateral rectus palsy, acquired non‐accommodative esotropia in childhood, late onset refractive accommodative esotropia, spasm of the near reflex and cyclic esotropia…”