Acute Acquired Comitant Esotropia in Adults: Is It Neurologic or Not?

Kadriye Erkan Turan,Tulay Kansu

doi:10.1155/2016/2856128

Abstract

Objectives. Acute acquired comitant esotropia (AACE) can be a diagnostic challenge for ophthalmologists and neurologists because of its association with neurological pathologies. Our study describes a series of adult patients with AACE of undetermined etiology. Methods. Data on the clinical findings of patients presented with AACE of undetermined etiology with a minimum follow-up of 1 year were retrieved from the medical records and the results analyzed. Results. A series of 9 esotropia cases (age range: 20–43 years) was reviewed. All patients had full duction and versions, without an A-pattern or V-pattern. All patients had esotropia for distance and near. Neurological evaluation in all cases was normal. Among patients, 3 were treated with prisms, 4 were treated with strabismus surgery, and 1 was treated with botulinum toxin injections; 1 patient declined treatment. In treated patients posttreatment sensory testing indicated restoration of binocularity that remained stable throughout follow-up of 1–9 years. The patient that declined treatment had binocular function with base-out prisms. Conclusion. Acute onset esotropia may be seen without a neurological pathology in adults. Good motor and sensory outcomes can be achieved in these patients with AACE of undetermined etiology via surgical and nonsurgical methods.

Highlights

Acute acquired comitant esotropia (AACE) is an unusual presentation of esotropia that occurs in older children and adults
AACE is categorized as 3 types, based on the clinical features and apparent etiology: type 1 (Swan type): acute onset esotropia following occlusion; type 2 (Franceschetti type): refractive error which is minimal hypermetropia without an accommodative element; type 3 (Bielschowsky type): AACE associated with myopia [3, 4]
We present 9 patients with AACE of undetermined etiology and a review of the relevant literature

Summary

Introduction

Acute acquired comitant esotropia (AACE) is an unusual presentation of esotropia that occurs in older children and adults. AACE is characterized by acute onset of a relatively large angle of esotropia, along with diplopia and minimal refractive error [1, 2]. AACE is not cyclical, it may initially be intermittent. It is comitant at distance and near fixation [1]. AACE is categorized as 3 types, based on the clinical features and apparent etiology: type 1 (Swan type): acute onset esotropia following occlusion; type 2 (Franceschetti type): refractive error which is minimal hypermetropia without an accommodative element; type 3 (Bielschowsky type): AACE associated with myopia [3, 4]. We present 9 patients with AACE of undetermined etiology and a review of the relevant literature

Objectives

Methods

Results

Discussion

Conclusion