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Low-dose atropine-related esotropia in a myopic child: a case report
Athanasia Sandali1, Michail Angelos Gkikas1, Anna Nikolaidou2
1Programme of Postgraduate Studies, MSc "Ocular Surgery", School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece.
Insights
Low-dose atropine (LDA) eye drops for myopia control in children may rarely cause esotropia, a form of strabismus. This case highlights the importance of monitoring for potential side effects during LDA treatment.
Area of Science:
- Ophthalmology
- Pediatric Ophthalmology
- Myopia Control
Background:
- Acute-onset strabismus in highly myopic children requires a broad differential diagnosis.
- Prolonged near focus and screen time are associated with myopia progression.
- Low-dose atropine (LDA) is increasingly used for myopia control.
Purpose of the Study:
- To report a rare case of esotropia developing during LDA treatment for myopia.
- To highlight potential side effects of LDA in pediatric myopia management.
Main Methods:
- A case report of a four-year-old male with high myopia and prolonged near focus.
- Treatment with 0.05% atropine eye drops for progressive myopia.
- Observation of strabismus development and management.
Main Results:
- The patient developed esophoria, which progressed to esotropia within one month of starting LDA.
- LDA treatment was discontinued due to myopia progression.
- The patient ultimately required strabismus surgery for persistent esotropia.
Conclusions:
- LDA is effective for myopia control but may have rare side effects like esotropia.
- This case is among the first to document esophoria converting to esotropia in a pediatric patient treated with LDA.
- Vigilant monitoring for strabismus is crucial during LDA therapy for myopia.
Aims/Purpose:
Acute-onset strabismus in highly myopic children raises a broad differential diagnosis. In this article, we report a pediatric case with high myopia and prolonged near focus who presented concomitant esotropia during treatment with atropine 0.05% eye drops.
Methods:
Case report.
Results:
A four-year-old male presented with progressive myopia, and a habit of prolonged near focus and excessive screen time. He had moderate myopia in both eyes, with no sign of strabismus. Due to the rapid progression of the refractive error over the next visits, low-dose atropine (LDA) drops 0.05% were prescribed. One month later, the patient developed esophoria which soon converted to esotropia. LDA treatment was discontinued with the child's axial length increasing, consistent with continued progression of myopia. Finally, he was switched over to peripheral defocus spectacles. Three years following his initial visit, his tests show stable visual acuity and AL and an esotropia measuring 45 PD. The patient has been scheduled for strabismus surgery.
Conclusions:
LDA is an increasingly useful method to control myopia progression; however, any potential side effects should be reported. To our knowledge, this case is one of the first reports of esophoria converting to esotropia in a young patient after atropine was used to control myopic progression.
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