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Risk Factors for Acute Acquired Comitant Esotropia in Children and Young Adults: A Systematic Review
Manjushri Yuan Rou Lee1, Mei Shi Pearl Lee1
1Orthoptics Department, Singapore National Eye Centre, Singapore.
Insights
Acute acquired comitant esotropia (AACE) risk factors are diverse, including benign conditions and serious neurological issues. Further research is needed to clarify causes and improve AACE management.
Area of Science:
- Ophthalmology
- Neurology
Background:
- Acute acquired comitant esotropia (AACE) is a rare condition occurring post-infancy.
- Its pathogenesis is unclear, with potential links to both benign and severe neurological conditions.
- Current diagnostic and management guidelines for AACE are not well-defined.
Purpose of the Study:
- To systematically review and summarize reported risk factors for AACE.
- To provide insights into the etiology of this rare ophthalmic condition.
Main Methods:
- A systematic review of studies from CINAHL, MEDLINE, Cochrane Library, and PubMed.
- Inclusion of studies on risk factors and clinical features of AACE in children and young adults.
- Critical appraisal and narrative synthesis of extracted data.
Main Results:
- Twelve studies were included in the review.
- Six studies reported benign risk factors, while eight identified non-benign factors.
- Non-benign risk factors included intracranial pathologies, multiple sclerosis, and head trauma.
Conclusions:
- Study findings have limited generalizability, preventing definitive conclusions on risk factor significance.
- Further prospective research is necessary to establish cause-effect relationships.
- Refining diagnostic criteria and management guidelines for AACE requires more objective data and larger studies.
Background:
Acute acquired comitant esotropia (AACE) is a rare subtype of esotropia that occurs after infancy. The exact pathogenesis of AACE remains unknown with aetiologies ranging from benign conditions to serious underlying neurological diseases being reported. Given the elusive characteristic of AACE, diagnostic and management guidelines remain unclear. This systematic review aims to contribute to this field by summarising the risk factors for AACE reported thus far.
Methods:
A systematic review was conducted with papers found in CINAHL, MEDLINE, Cochrane library, PubMed databases and other sources. Eligible studies investigating the risk factors for, and clinical features of, AACE in children and young adults were critically appraised before relevant data were extracted and discussed via a narrative summary.
Results:
Twelve studies were included in the final review, of which six and eight papers reported on benign and non-benign risk factors for AACE respectively. Identified benign risk factors varied among studies, while non-benign risk factors were associated with intracranial pathologies, multiple sclerosis and head trauma.
Conclusion:
Given the low generalisability of study findings, no definitive conclusions can be drawn on the significance of each risk factor on AACE development. Further prospective research with more objective measurements of 'near work', larger sample sizes and control groups is required to better ascertain any cause-effect relationship, refine the diagnostic criteria for each AACE subtype and advise on appropriate management guidelines for AACE.
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