Clinical characteristics and aetiology of acute acquired comitant esotropia

ABSTRACT Clinical relevance Acute acquired comitant esotropia (AACE) is characterised by the acute onset of diplopia which affects work and life. Background To describe the clinical characteristics and discuss the aetiology of acute acquired comitant esotropia. Methods The medical records of 51 patients with AACE were retrospectively analysed, and their age, occupation, daily average time spent on near work, angle of deviation, refractive error and aetiology were analysed. Results The age at onset of AACE was eight to 55 years. Thirty-nine patients were aged 12 to 36 years (76.5%), and 42 patients (82.4%) were myopic. The angle of deviation was 20Δ (12Δ to 35Δ) during near fixation and 25Δ (18Δ to 40Δ) during distance fixation. The deviation during distance fixation was larger than that during near fixation, the difference being statistically significant (p < 0.001). The daily average time of near work before onset was 9.0 h (8.0 h to 10.0 h); 35 patients (68.6%) spent more than 8 h performing near work. Their occupations included students, accountants, information technology staff, and those who required electronic use for a long time. There is no correlation between the angle of deviation and the time of near work (p > 0.05). Among the 51 patients, three had intracranial diseases. Diplopia resolved in 47 cases following treatment. The angle of deviation post-treatment was 0Δ (0Δ to 5Δ) during near and 0Δ (0Δ to 3Δ) during distance fixation. Conclusion AACE occurs mostly in myopic older children and adults. The onset of esotropia is related to long-term near work. AACE patients mostly present an angle of deviation that is larger during distance than near fixation. Intracranial disease is an infrequent but important cause of AACE that needs to be excluded in all cases.