Acute onset concomitant esotropia

To browse Academia. Skip to main content. Log In Sign Up. Download Free PDF. The role of botulinum toxin a in acute-onset esotropia 1 Ophthalmology, Gillian Adams.

Download PDF. A short summary of this paper. The role of botulinum toxin a in acute-onset esotropia 1. Acute, acquired concomitant esotropia is a rare but wellrecognized condition of unknown etiology characterized by the dramatic onset of a relatively large-angle concomitant esotropia with no evidence of lateral rectus underaction.

It tends to occur in older children. There may be a brief period of intermittency, but it soon becomes constant. In Burian and Miller 2 described three types of acute esotropia. Type 1 acute onset of concomitant convergent strabismus follows artificial interruption of fusion after a period of monocular occlusion or loss of vision in one eye.

Type II convergent strabismus of the Franceschetti type is an acute esotropia with a large angle, absence of signs of paralysis, and good potential for binocular cooperation. The patients have low hypermetropia with a minimal accommodative element. Type III concomitant convergent strabismus of the Bielschowsky type is of acute onset in myopic patients of 5 diopters D or less.

The onset often follows shock or exhaustion and consists of uncrossed diplopia for distance, with fusion for near, and no evidence of lateral rectus paralysis. Higher levels of myopia and a constant deviation at both near and distance fixation are now included in the characteristics of this form of acute-onset esotropia.

This agent has several advantages over prisms, which distort the image, limit fusion, and are difficult to wear. Timms et al 4 therefore recommended the use of BTXA as first-line treatment of this condition. The purpose of this study is to determine the efficacy of BTXA in the treatment of acute-onset esotropia.

Materials and MethodsA retrospective analysis of case records of patients presenting to Moorfields Eye Hospital Strabismus and Pediatric Service was performed using the Botulinum Toxin Clinic database of over patients.

A period of 6 years between and was arbitrarily chosen. Nineteen patients with acute-onset esotropia were identified.

Acute onset concomitant esotropia: when is it a sign of serious neurological disease?

Five patients were excluded because they either lacked full abduction, had a previous ophthalmic history, or had evidence of neurologic abnormality. One child had worn a low myopic correction for 3 years before the onset of acute esotropia.

A complete history was taken, including general health, birth history, family history, and previous ocular history. All patients underwent full ophthalmic and orthoptic examinations, including a fundus and media check and a cycloplegic refraction.

Ocular movements, range of convergence, and assessment of binocular functions including fusion and stereopsis were also performed. Where no binocular function was demonstrable in free space, patients were assessed on the synoptophore.

All children were treated with BTXA injected into the unilateral medial rectus of the deviating eye.

The role of botulinum toxin a in acute-onset esotropia 1

Owing to their young age, this was performed under general anesthesia in all but one patient, who was able to tolerate injection under local anesthesia as an outpatient procedure. The anesthetic agent was ketamine in eight patients and light inhalational sevoflurane in five patients.

acute onset concomitant esotropia

The epinephrine reduces the likelihood of conjunctival hemorrhage and allows the anterior ciliary vessels to be seen more clearly, providing a useful guide to the location of the muscle to be treated.This is an observational case series of five cases of acute acquired comitant esotropia AACE with diplopia, aged between 5 and 12 years.

The duration of presenting complaints ranged from 4 days to 2 months. A detailed ophthalmic evaluation and neuroimaging were done on all patients. Three patients were found to have intracranial pathology.

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Two patients had pontine glioma and one patient had benign intracranial hypertension. One patient was diagnosed as accommodative spasm and one patient was diagnosed as having Type 2 AACE. We would like to conclude that AACE can be of a varied aetiology ranging from convergence spasm to those harboring serious intracranial diseases.

We reiterate that AACE has a small but significant association with intracranial disorders. Neuroimaging is a definite need in cases which cannot be proved to be either Type 1 or 2. Editorial Board Subscribe Advertise Contact. Varied aetiology of acute acquired comitant esotropia: A case series.

Oman J Ophthalmol ; Case Report.

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Table 1: Table showing the clinical features of the five cases with acute acquired comitant esotropia Click here to view. Figure 1: Picture of case five showing left esotropia with full horizontal versions Click here to view.

Figure 2: a Fundus photograph of the right and left eye of case two showing papilloedema b Fundus photograph of the right and left eye of case two showing normal discs after treatment Click here to view. Figure 3: Axial FLAIR a and coronal b MRI brain showing a large intra-axial lesion arrows with cystic and solid component most likely a glioma causing expansion of the brain stem Click here to view.

Acute onset concomitant esotropia: When is it a sign of serious neurological disease? Br J Ophthalmol ; Binocular vision and ocular motility: Theory and management of strabismus. St Louis: Mosby; Kothari M. Clinical characteristics of spontaneous late onset acute comitant nonaccomodative esotropia in children.Metrics details. The treatment efficacy of botulinum toxin bilateral medial rectus injections for acute acquired concomitant esotropia AACE in adult is not clear. In this prospective, nonrandomized, controlled clinical study, patients with AACE in our hospital from March to March elected to receive bilateral medial rectus injections of botulinum toxin or to undergo extraocular muscle surgery.

Ocular position and stereopsis were evaluated before and after treatment. A total of 60 patients were treated: 40 patients in the botulinum toxin group, and 20 patients in the surgery group. The injection of botulinum toxin has a good effect on AACE in adults and children. The outcomes achieved with injected botulinum toxin are similar to those achieved with surgery. Registered May 2,Retrospectively registered. Peer Review reports. The incidence rate of acute acquired concomitant esotropia has increased dramatically, especially in Asian countries [ 12345 ].

There are various treatments for AACE, includes extraocular muscle surgery, botulinum toxin injection, prisms, and divergence training. However, no standard protocol for treatment has been established. Extraocular muscle surgery remains the main treatment method. Many authors have published satisfactory results in the treatment of various types of strabismus in children, including AACE, with botulinum toxin [ 129111213141516171819 ].

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However, the effects of this approach to treatment remain to be evaluated in an adult patient population. Recently, some reports on treating AACE with botulinum toxin included some adult patients, but because the number of cases is small, the authors did not discuss the effects of this approach to treatment on adults in particular [ 12 ].

The efficacy of this approach needs to be further investigated. The diagnostic criteria were: sudden-onset esotropia with diplopia, same esotropia angle in each direction, and normal eye movements in each direction. Patients with refractive accommodative esotropia ,with history of surgery or extraocular muscle botulinum toxin injection were excluded. After a detailed medical history had been obtained, preoperative assessments of vision, refractive error, ocular duction, vergence and stereopsis were obtained.

In this prospective, non-randomized, controlled clinical study, patients were divided into two groups: a botulinum toxin group and a surgery group. Patients voluntarily chose to undergo surgery or treatment with botulinum toxin.

However, if patients strongly desired to receive botulinum toxin treatment, we did not refuse. If the patient was not cured after 3 doses, surgery was recommended. The patient was placed in a supine position. After anesthesia had been administered, the eyelids were opened, the medial rectus muscle was clamped, and the eye was rotated in abduction with tooth forceps.

The approach to surgery was determined by the maximum angle of deviation observed preoperatively. If the patient complained of diplopia or slight residual esotropia immediately after surgery, adjustments were made within one week. Patients were followed for at least six months. The criteria for successful treatment were the resolution of diplopia at distance and near and alignment within 10 PD or orthotropia. Subjects with residual deviations treated secondarily with sutures, botulinum toxin injection, or strabismus surgery were considered treatment failures, regardless of their final results.

Those patients received additional injections of botulinum toxin or underwent reoperation. Deviation data at six months after primary treatment and at the last follow-up appointment including further treatment for residual deviation and relapse were recorded. The final number of successfully treated cases was defined as the initial number of successful cases minus the number of recurrences. Patients who rejected our treatment were advised to reduce the amount of time devoted to near-work, to engage in binocular vision training at home, and to schedule regular follow-up visits.

SPSS version Either your web browser doesn't support Javascript or it is currently turned off. In the latter case, please turn on Javascript support in your web browser and reload this page. Review Free to read. Read article at publisher's site DOI : Jpn J Ophthalmol63 623 Sep Cited by: 2 articles PMID: BMC Ophthalmol19 107 Aug J Pediatr Ophthalmol Strabismus56 201 Mar Cited by: 0 articles PMID: J Pediatr Ophthalmol Strabismusee44, 19 Dec Am J Ophthalmol, 24 Jul Free to read.

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Europe PMC requires Javascript to function effectively. Recent Activity. Recent history Saved searches.Studies on the botulinum therapy for esotropia improvement of retinal correspondence. Acute concomitant esotropia of adulthood. J PediatrOphthalmol Strabismus e70— Clipboard, Search History, and several other advanced features are temporarily unavailable.

Special thanks to our referring pediatric ophthalmologist, Dr. The clinical characteristics, history of smartphone use among the patients diagnosed with AACE over a two year period are reported here. Clinical characteristics and surgical outcomes of adults with acute acquired comitant esotropia. Front Pharmacol 4: An iconic optometrist, A. Skeffington, noted that the origin of many binocular visual problems is rooted in socially compulsive, biologically unacceptable, sustained nearpoint tasks — for which the Smartphone is a poster child.

Neurological examination, including CT scan, in each of these children gave negative results. Acquired or secondary esotropia, which develops later in life, can occur for a variety of reasons: Accommodative esotropia is eye crossing that results from the focusing efforts of the eyes.

The average age of the patients was Greetings from Colorado! Comitant convergent strabismus with acute onset. Controversies about the enhanced vulnerability of the adolescent brain to develop addiction. Setting: Institutional. Residence Day, Author Affiliation:. The habit of long-time sustained near work on these devices may increase the risk of inducement of AACE.

Strabismus surgery was performed under topical anesthesia with adjustable sutures wherever possible. Among these, two cases were with mild hypermetropia; 24 patients were myopic with spherical equivalents of A survey about smartphone addiction conducted by the National Information Society Agency from Korea in showed that addiction rates were highest in teenagers, which illustrated adolescents were more vulnerable to smartphone addiction.

Visual stress and a shift in the inward or eso binocular direction has long been associated with sustained nearpoint activities, and Smartphone compounds this because of the font size, usage pattern, and close working distance often well inside the Harmon distance.

Rosenbloom, Jr. Peters Memorial Award, Michael G. It is characterized by the acute onset of esotropia with diplopia.

acute onset concomitant esotropia

The absolute causation of smartphone use and AACE can only be proven by a controlled prospective study. Necessary cookies are absolutely essential for the website to function properly. Asian J Psychiatry 96— Your email address will not be published.

Save my name, email, and website in this browser for the next time I comment. Notify me of follow-up comments by email. Notify me of new posts by email. This site uses Akismet to reduce spam.Background and objective: Acute acquired concomitant esotropia is a rare form of strabismus that usually presents during infancy or early childhood with diplopia and minimal refractive error. The aim of this study was to evaluate the response to the prism adaptation test in a group of normosensorial patients with acute acquired concomitant esotropia and to determine its predictive value for surgical outcome.

Patients and methods: Six patients median age, The sensorial condition of each patient had been evaluated with theTNO stereopsis test, the Irvine test, Bagolini striated glasses, and the Worth four-dot test during the prism adaptation test, when maximum compensation angle was achieved, and after surgery. In all patients, surgery was performed based on the angle of the squint after the prism adaptation test.

acute onset concomitant esotropia

Patients were observed 1 day, 3 months, 6 months, and 1 year after surgery. Results: An increase in the angle of the squint occurred in all patients during prism adaptation. The maximum value was obtained in the same amount of time whether with prisms of increasing power or by direct application of the final value of the prisms. The final prismatic value target angle was always the same.

Conclusions: The accuracy of the patients' selection confirmed the existence of highly reproducible compensational movements to the prismatic correction in not only patients with anomalous retinal correspondence but also normosensorial patients. Prism adaptation test results were useful in these patients because of their high predictive value for the surgical treatment. Abstract Background and objective: Acute acquired concomitant esotropia is a rare form of strabismus that usually presents during infancy or early childhood with diplopia and minimal refractive error.

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Treatment of acute acquired concomitant esotropia

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acute onset concomitant esotropia

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Understanding Accomodative Esotropia

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