Spontaneous consecutive sensory esotropia: a case series

Area of Science:

• Ophthalmology
• Pediatric Neurology
• Strabismus Research

Background:

• Strabismus, or eye misalignment, can present as exotropia (outward deviation) or esotropia (inward deviation).
• Sensory strabismus occurs secondary to decreased vision in one eye.
• Spontaneous shifts in strabismus type are uncommon, particularly from exotropia to esotropia without intervention.

Purpose of the Study:

• To report the first case series of spontaneous conversion from sensory exotropia to sensory esotropia in children without systemic neurologic disease.
• To analyze the clinical characteristics and potential implications for strabismus management.

Main Methods:

• Retrospective case series analysis.
• Review of clinical data including ocular alignment, visual acuity, refractive error, and accommodative function.
• Longitudinal follow-up of patients presenting with unilateral ocular pathology and initial exotropia.

Main Results:

• Patients initially presented with exotropia within the first two years of life due to unilateral ocular pathology.
• All patients spontaneously converted to esotropia between ages 4 and 8 years.
• A high accommodative convergence to accommodation (AC/A) ratio was observed post-conversion.
• No clear relationship was found between refractive error and the development of spontaneous esotropia.

Conclusions:

• The spontaneous conversion from sensory exotropia to esotropia is a rare but documented phenomenon.
• The high AC/A ratio observed may play a role in the development of esotropia.
• This entity supports considering delayed surgical intervention for strabismus in patients with sensory exotropia.