Development of refractive accommodative esotropia in children initially diagnosed with pseudoesotropia

To determine the clinical characteristics of children with pseudoesotropia who later develop refractive accommodative esotropia.

We retrospectively reviewed the records of consecutive patients diagnosed with pseudoesotropia from 2003 to 2010. Inclusion criteria included age 3 years or younger at the time of diagnosis, history of strabismus, verifiable positive or negative family history of strabismus, hypermetropia detected with atropine refraction, prism and cover test measurements performed with and without refractive correction at follow-up visits, and a minimum follow-up of 1 year.

A total of 51 children met inclusion criteria (average age, 1.48 ± 0.79 years; range, 3-36 months; mean follow-up, 2.9 years). Refractive accommodative esotropia developed in 15.7% of the children at a mean age of 2.78 ± 1.06 years. It developed in 53.9% of the children with pseudoesotropia who had >1.50 D of hypermetropia compared to 2.6% of those who had ≤ 1.50 D hypermetropia (P = 0.0001). A positive family history of strabismus (P = 0.193) and initial age at presentation with pseudoesotropia (P = 0.571) were not predisposing factors.

Children aged ≤ 3 years diagnosed with pseudoesotropia should undergo cycloplegic refraction. If >1.50 D hypermetropia is detected, patients should be monitored for the development of refractive accommodative esotropia.