Abstract
Introduction. Esotropia is a form of strabismus that can give the affected individual a “cross-eyed” appearance. Acute onset of esotropia is an uncommon form; in the vast majority of cases, no underlying neurological etiology is found. Case Presentation. A 22-year-old female with a long history of opiate abuse presented with acute onset of diplopia. She noted her eyes were crossing and started seeing double. She stopped using heroin 11 days prior to presentation. There was large inward deviation of her left eye. Convergence was difficult and accompanied by horizontal nystagmus. Diplopia resolved by covering each eye. Further investigations including imaging studies were normal. Discussion. Acute onset esotropia is rare and must be investigated right away to exclude central nervous system pathologies, where no opiates use is reported. Diplopia in the form of acute esotropia may manifest in up to 30% of individuals undergoing heroin withdrawal. Evaluating acute esotropia requires detailed information of medical history with an emphasis on drug use. Conclusion. Acute onset esotropia with double vision can be caused by abrupt withdrawal of opiates. This case should serve to raise awareness among health care professionals, to avoid costly and unnecessary diagnostic evaluations and interventions.
Highlights
Esotropia is a form of strabismus that can give the affected individual a “cross-eyed” appearance
The first cases of diplopia or blurred vision following heroin withdrawal were reported in returning US soldiers who served in Vietnam with an incidence of 10%– 33.3% [3]
Due to the current resurgence of heroin use, we present case of a young woman who presented to our hospital with acute onset double vision during the beginning of her heroin detoxification
Summary
Esotropia is a form of strabismus or “squint” in which one or both eyes turn inward. The condition can be present constantly or occur intermittently and can give the affected individual a “cross-eyed” appearance. Esotropia can be caused by structural restriction of eye movements (e.g., thyroid eye disease, fracture), palsies (6th nerve, increased intracranial pressure), skull base tumour or lesion (e.g., Arnold Chiari malformation), autoimmune disease (e.g., myasthenia gravis) or idiopathic. People suffering from this condition might complain of double vision (diplopia). Acute onset of esotropia in the presence of full range of ocular movements is an uncommon form; in the vast majority of cases, no underlying neurological etiology is found [1]. Due to the current resurgence of heroin use, we present case of a young woman who presented to our hospital with acute onset double vision during the beginning of her heroin detoxification
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