Management of acute comitant esotropia at early stage

Abstract

Objective To investigate the effect of injection of botulinum toxin A (BTXA) on acute comitant esotropia (ACE) at early stage. Methods The injection of BTXA in 6 patients with ACE from April 2010 to March 2011 in Shandong Eye Institute were retrospectively analyzed.The mean age at presentation was 24.5 years,and the average time from onset of acute esotropia to injection was 10 weeks.The mean angel of esotropia was equal for distance and for near fixation (differing by ＜5 prism diopters),measurd by the prism and cover tests,which was +25△.The range of fusion was lower than normal,which was -3.3°～ +9.2°.A minimal conjunctival incision was made under a microscope,followed by the injection of BTXA in the medial rectus of the squinting eye.Results After the injection,all patients did not develop ptosis and exotropia during the follow-up of 6 to 18 months.Five patients obtained eye orthotroplia,disappearance of diplopia and increasing fusion.One patient who suffered from diplopia received the injection again 3 months after first injection.This patient underwent a surgical treatment at 11 months after onset because of esotropia and diplopia which repeatedly occurred. Conclusions Injection of BTXA is satisfactory and effective management of ACE at early stage. Key words: Acute comitant esotropia; Botulinum toxin A; Microsurgery