Acute concomitant esotropia of adulthood

Abstract

Purpose:To identify the characteristics of adult patients who develop acute concomitant esotropia of adulthood.Design: Retrospective noncomparative case series. Participants: Ten patients were included in this study. Intervention:The charts of all adults with acute-onset concomitant esotropia who were examined at our institute between 1990 and 1997 were reviewed, and those who had developed the syndrome when they were older than the age of 16 years were included in this study. All participants underwent a complete ocular and physical examination, including brain and orbital computed tomography.Main Outcome Measures: Angle of esotropia, measured by the prism and cover test. Results:The mean age Ϯ standard deviation at the time of the ocular and physical examination was 38 Ϯ 18.6 years (range, 18 -70 years). The mean myopic error was Ϫ4.1 Ϯ 3.2 diopters (range, ϩ2.0 to Ϫ8.5 diopters). Nine of the 10 patients were myopic. The mean angle of esotropia was 33.8 Ϯ 14.7 prism diopters (range, 18 -60 prism diopters). The mean period of follow-up was 2.2 Ϯ 1.0 years (range, 1-4 years). After surgery, all patients were orthophoric or minimally esophoric, and in all of them, stereoacuity (measured by the Titmus stereofly test) was 40 arc seconds.Conclusions: In a well-defined group of adult patients with acute-onset concomitant esotropia, almost all were myopic, and all regained normal stereopsis after surgery. Acute concomitant esotropia of adulthood should probably be classified as a distinct subgroup of acute-onset esotropia.

Decompensated Esophoria as a Benign Cause of Acquired Esotropia

“…Type III reportedly occurs in patients with uncorrected myopia of −5.00 D or more 17,18 , although given the extremely high prevalence of myopia in the 21 st century 19,20 this would seem a highly non-specific association indeed. One hypothesized mechanism for this type of esotropia is putative increased medical rectus muscle tone due to excessive convergence during near viewing by uncorrected myopes 17 ; this theory is undercut both by the absence of any measurable index of medial rectus tonus, and the relative rarity of AACE relative to the very high prevalence of myopia today. Some patients with AACE have large esotropia at distance but close to orthophoria at near 17 .…”

“…Type I occurs following monocular occlusion or vision loss secondary to ocular disease or trauma 16 , and is not inconsistent with decompensation of an esophoria due to sensory deprivation. Type II is characterized by presence of hypermetropia and reportedly occurs after psychological stress or shock 17 ; such a postulated etiology is subject to recall bias and has not been supported by a controlled study. Type III reportedly occurs in patients with uncorrected myopia of −5.00 D or more 17,18 , although given the extremely high prevalence of myopia in the 21 st century 19,20 this would seem a highly non-specific association indeed.…”

“…Type II is characterized by presence of hypermetropia and reportedly occurs after psychological stress or shock 17 ; such a postulated etiology is subject to recall bias and has not been supported by a controlled study. Type III reportedly occurs in patients with uncorrected myopia of −5.00 D or more 17,18 , although given the extremely high prevalence of myopia in the 21 st century 19,20 this would seem a highly non-specific association indeed. One hypothesized mechanism for this type of esotropia is putative increased medical rectus muscle tone due to excessive convergence during near viewing by uncorrected myopes 17 ; this theory is undercut both by the absence of any measurable index of medial rectus tonus, and the relative rarity of AACE relative to the very high prevalence of myopia today.…”

Acute Acquired Comitant Esotropia in Adults: Is It Neurologic or Not?

“…This form of esotropia is observed in elderly patients and is not associated with LR muscle underaction or with any known neurological pathology [29, 38, 39]. ARDET is considered a form of divergence insufficiency, although some consider it a distinct clinical entity [29, 38, 40]. ARDET shares some features with AACE types 2 and 3 but differs from them in several ways.…”

Esotropia do adulto durante o período gestacional: relato de caso

“…A conduta expectante ou o tratamento clínico com prisma e expectante podem ser realizados, especialmente em pacientes com alterações neurológicas, devido à possibilidade de melhora da esotropia nesses casos. No entanto a grande maioria deles necessita de tratamento cirúrgico (1)(2)(3)(6)(7) . A esotropia tipo Franceschetti ocorre em indivíduos jovens, emétropes ou ligeiramente hipermétropes, sem sinal de neuropatia.…”