The effects of topical cycloplegics in acute acquired comitant esotropia induced by excessive digital device usage

Abstract

Background Acute acquired comitant esotropia induced by excessive digital device usage, especially smartphones (SAACE), has been increasing over the past few years. One suggested mechanism is convergence spasm induced by excessive near work, with refraining from digital device use considered to be an effective method for decreasing the degree of esodeviation. However, if symptoms persist and are untreated over time, recovery becomes more difficult. The present study evaluated the effects of topical cycloplegics on persistent SAACE untreated for over 1 year. Methods Patients with sustained SAACE that was untreated for over 1 year were evaluated. Digital device usage was discouraged and a topical cycloplegic, 0.4% tropicamide, was prescribed at bedtime. After obtaining informed consent, the 14 out of 23 enrolled patients who agreed to eye drop administration were defined as the study group, with the others serving as the controls. After a 3-month follow-up, patients who elected to undergo surgery were analyzed as the surgery group. Changes in esotropia angles, stereoacuity and diplopia complaints were evaluated after a 3-month follow-up. Results Esotropia angles decreased and stereoacuity improved after a 3-month treatment in the study group (P < 0.01). Diplopia disappeared in 13 patients (92.9%, totally disappeared or disappeared when using glasses with built-in prisms). Among 11 patients with untreated esotropia ranging from 1–3 years, decreases in esotropia angles were correlated to untreated esotropia duration (near: R = -0.6; distance: R = 0.7; both P < 0.05). Esotropia angles in the control group exhibited a tendency to increase while stereoacuity tended to deteriorate after the 3-month follow-up. As diplopia did not disappear in any patients, 7 elected to undergo surgery and were enrolled as the surgery group. While esotropia angles decreased in the study group, they were lower than the surgery group (P < 0.01), but higher than the control group (P < 0.01). Stereoacuity was worse in the control versus the study and surgery groups (both P < 0.05). Conclusion Results suggest short-acting topical cycloplegics are effective in SAACE patients with long untreated periods. Decreases in esotropia angles were negatively correlated to untreated esotropia duration, which suggests the necessity of early treatment.

Simultaneous Development of Acute Acquired Concomitant Esotropia in Two Siblings during the COVID-19 Pandemic: A Case Report

“…Whilst favourable outcomes of AACE treated with strabismus surgery is well recognised ( Lee et al 2016 ; Hayashi et al 2022 ; Neena et al 2022 ; Wu et al 2022 ), conservative approaches have also been trialled. Wu et al .…”

“…Hayashi et al . ( 2022 ) recognised that cases of sustained AACE are difficult to treat. They assessed the role of topical cycloplegics in smartphone associated AACE that has been untreated for more than one year by conducting a case–control study.…”

“…( 2022 ), Hayashi et al . ( 2022 ) found that there was a negative correlation between a longer duration from onset to treatment and the effectiveness of treatment.…”

“…Whilst favourable outcomes of AACE treated with strabismus surgery is well recognised (Lee et al 2016;Hayashi et al 2022;Neena et al 2022;Wu et al 2022), conservative approaches have also been trialled. Wu et al (2022) evaluated the role of step-by-step increase of Fresnel Prism power for the treatment of smartphone associated AACE causing esodeviations of 25Δ and less.…”

“…Wu et al (2022) found that treatment is more likely to be successful in patients with a shorter duration between onset and treatment, and in patients with smaller angles of deviation. Hayashi et al (2022) recognised that cases of sustained AACE are difficult to treat. They assessed the role of topical cycloplegics in smartphone associated AACE that has been untreated for more than one year by conducting a case-control study.…”