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Acute acquired comitant esotropia simulating late onset accommodative esotropia.

¹School of Optometry/Medical Center, University of Alabama, Birmingham 35294.

Journal of the American Optometric Association

|June 1, 1988

Summary

Acute acquired comitant esotropia in young adults may not always stem from uncorrected hyperopia. Sometimes, high hyperopia is coincidental, masking other serious underlying causes like brain tumors.

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Clinical course of accommodative esotropia.

Optometry and vision science : official publication of the American Academy of Optometry·1998

Area of Science:

Ophthalmology
Neurology

Background:

Acute acquired comitant esotropia (AACE) in older children and young adults is often presumed to be due to uncorrected accommodative esotropia.
This assumption may lead to misdiagnosis and delayed treatment of underlying conditions.

Observation:

Three young patients presented with sudden onset diplopia and AACE.
Cycloplegic refraction revealed significant uncorrected hyperopia in all cases, initially suggesting accommodative esotropia.

Findings:

One patient's esotropia was precipitated by an intracranial neoplasm.
For the other two patients, correcting the hyperopia did not resolve the strabismus, indicating the hyperopia was coincidental.
This highlights that high hyperopia can mask other pathologies causing AACE.

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Implications:

Clinicians should exercise caution when diagnosing AACE associated with hyperopia in older patients.
Consideration of neurological causes and thorough investigation are crucial, as hyperopia may be a red herring.
Prompt diagnosis and management of underlying conditions are essential for favorable outcomes.