Acute Acquired Concomitant Esotropia: Clinical features, Classification, and Etiology

Area of Science:

• Ophthalmology
• Neuro-ophthalmology
• Strabismus Research

Background:

• Acute acquired concomitant esotropia (AACE) is a rare and distinct form of esotropia.
• Understanding its clinical characteristics is crucial for diagnosis and management.
• Previous classifications and etiological factors require further elucidation.

Purpose of the Study:

• To describe the clinical characteristics of AACE.
• To discuss potential classifications for AACE.
• To investigate the underlying etiology of AACE.

Main Methods:

• Retrospective review of 47 AACE patient charts.
• Inclusion of comprehensive ophthalmologic, orthoptic, and neuroimaging evaluations.
• Analysis of patient demographics, deviation characteristics, and treatment outcomes.

Main Results:

• Mean age at onset was 26.6 years.
• Patients with deviations ≤ 20 PD often responded well to prism correction.
• Patients with deviations > 20 PD, particularly myopic or emmetropic individuals, frequently required surgical intervention, achieving positive visual outcomes.
• Rare instances of neurological conditions (cerebellopontine angle tumor, spinocerebellar ataxia) were identified.

Conclusions:

• AACE presents with sudden onset, non-accommodative esotropia, diplopia, or visual confusion in individuals aged 5 years or older.
• AACE can be subcategorized into small (<20 PD) and large (>20 PD) angle deviations.
• Underlying neurological diseases are infrequent causes of AACE, and many patients can achieve normal binocular vision.