Managing acute acquired comitant esotropia - importance of appropriate refraction and myopic prescriptions: a case...

Acute acquired comitant esotropia (AACE) is a subtype of non-accommodative esotropia for which the exact underlying mechanism remains unclear. With most AACE adults being myopic, it is crucial to detect and rectify myopic over-correction in AACE considering its possible role in inducing and/or worsening eso-deviations. This report aims to emphasize the importance of appropriate refraction and suitable myopic prescriptions in managing AACE.

This report presents two middle-aged patients with moderate myopia who were diagnosed with AACE. At initial presentation, both were found to have varying AACE control and angles ranging from 4∆ to 14∆ on prism cover test. Manifest refraction with fogging revealed that they have been over-corrected for myopia. Immediate improvements in AACE symptoms, control and measurements were noted with new myopic prescriptions - one fully corrected and the other intentionally under-corrected - of a difference in at least -0.38 diopter sphere (spherical equivalent) in both eyes alone.

Appropriate and early refraction alongside well-fitted prescriptions is essential in managing AACE. Further research is required to establish the potential of intentional myopic under-correction as a new, alternative conservative management for AACE.