Risk factors for consecutive esotropia

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Purpose The aim of this retrospective study was to investigate the different factors predisposing to consecutive esotropia (CET) after surgical management of intermittent exotropia (IXT). Patients and methods This study included the medical records of patients who had surgery for IXT from March 2016 to March 2017. Postoperatively, the patients were divided into two groups: A group who developed CET and another group who became orthotropic within 6 months of follow-up. Possible risk factors for the development of CET were recorded and analyzed. Results Eighteen patients developed CET, while the orthotropic group consisted of 78 cases. CET occurred in 61% of patients of less than 6 years old. There was no significant correlation between preoperative angle of IXT and development of CET, but there was significant correlation with the angle of initial CET (postoperatively). CET was found in 16.7% of preoperative tenacious proximal convergence exotropia. CET was developed in 66.7% of cases of asymmetrical surgery (recession–resection), and more common with the development of lateral incomitance (27.8%). Amblyopia, suppression, and absence of stereopsis were considered risk factors in 50% of the cases. No correlation between errors of refraction and development of CET. Conclusion This study concluded that many risk factors may predispose to CET, the more significant factors were the age of the patients (<6 years old), large angle of initial postoperative CET, type of IXT, asymmetric surgery (recession–resection procedure), development of lateral incomitance, and presence of amblyopia or suppression.