Possibility of Neurological Diseases Associated with Acute Acquired Comitant Esotropia
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Purpose: This study investigated the possibility of neurological etiologies causing acute acquired comitant esotropia (AACE)and to evaluate the differences in clinical features between younger children, older children, and adults. Methods: In this retrospective analysis, patients who had been diagnosed with AACE between July 2017 and June 2021 wereincluded. Data on clinical findings, medical history, brain or orbital imaging, and ophthalmological and orthoptic examinationswere retrieved from medical records and analyzed. Patients were divided into three groups based on their age: younger children(<10 years), older children (10–18 years), and adults (>18 years). Results: Overall, 41 patients with AACE (15 females and 26 males) were examined. Most patients were children. Mild hyperopiawas observed in children, while adults had moderate to high myopia. The mean angle of esotropia at a distance fixationwas 43.57 ± 9.77, 51.54 ± 8.75, and 30.14 ± 12.39 prism diopters (PD) in younger children, older children, and adult groups,respectively. The mean angle of esotropia at a near fixation was 43.57 ± 9.37, 51.15 ± 9.39, and 31.43 ± 12.15 PD in youngerchildren, older children, and adult groups, respectively. Significant differences were found in the mean angles of esotropiain patients with AACE at both near and far distances according to their age (all p < 0.001). Among 36 patients with previousneuroimaging data, none had AACE secondary to intracranial lesions. Over 2 years, five patients who were under continuousobservation did not develop any neurological abnormalities. Conclusions: AACE was more common in children than in adults. The angle of deviation was larger in children than in adults. Coexisting or underlying neurological diseases were not present in patients with isolated AACE, which eliminated the need forneuroimaging. Continuous follow-up evaluations are warranted when signs of intracranial disease are observed in patientswho have not undergone an imaging investigation.
Abstract
Purpose: This study investigated the possibility of neurological etiologies causing acute acquired comitant esotropia (AACE)and to evaluate the differences in clinical features between younger children, older children, and adults. Methods: In this retrospective analysis, patients who had been diagnosed with AACE between July 2017 and June 2021 wereincluded. Data on clinical findings, medical history, brain or orbital imaging, and ophthalmological and orthoptic examinationswere retrieved from medical records and analyzed. Patients were divided into three groups based on their age: younger children(<10 years), older children (10–18 years), and adults (>18 years). Results: Overall, 41 patients with AACE (15 females and 26 males) were examined. Most patients were children. Mild hyperopiawas observed in children, while adults had moderate to high myopia. The mean angle of esotropia at a distance fixationwas 43.57 ± 9.77, 51.54 ± 8.75, and 30.14 ± 12.39 prism diopters (PD) in younger children, older children, and adult groups,respectively. The mean angle of esotropia at a near fixation was 43.57 ± 9.37, 51.15 ± 9.39, and 31.43 ± 12.15 PD in youngerchildren, older children, and adult groups, respectively. Significant differences were found in the mean angles of esotropiain patients with AACE at both near and far distances according to their age (all p < 0.001). Among 36 patients with previousneuroimaging data, none had AACE secondary to intracranial lesions. Over 2 years, five patients who were under continuousobservation did not develop any neurological abnormalities. Conclusions: AACE was more common in children than in adults. The angle of deviation was larger in children than in adults. Coexisting or underlying neurological diseases were not present in patients with isolated AACE, which eliminated the need forneuroimaging. Continuous follow-up evaluations are warranted when signs of intracranial disease are observed in patientswho have not undergone an imaging investigation.
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