Refractive accommodative esotropia following monocular patching

To report a case of new-onset refractive accommodative esotropia following monocular occlusion OD.

Retrospective case report.

A previously orthotropic 4-year-old girl with good vision OU was patched OD for 5 days after dacryocystorhinostomy. After the patch was removed a variable right inward eye turn was noted and the patient later complained of diplopia. A cycloplegic refraction revealed +3.00 diopters OU, which she was prescribed for full-time wear with part-time occlusion OS. With correction, she showed a small esophoria at distance and near. Without correction, she showed a comitant esotropia at distance and near.

All children scheduled for periocular surgery should undergo a preoperative eye exam that includes assessment of ocular motility and cycloplegic refraction. Monocular patching in susceptible children should be minimized as it can disrupt binocular vision.