Clinical features and treatment of near-work-related acquired esotropia

Abstract

AIM: To investigate the characteristics of near-work-related esotropia and the clinical efficacy of botulinum toxin type A (BTXA) injection therapy on it. METHODS: A total of 107 patients aged 15-57y with near-work-related esotropia were taken as the BTXA-treated group, and 30 other peers without near-work-related esotropia were included in the control group. All participants were refractive corrected to analyse the clinical characteristics of near-work-related esotropia. All subjects were examined including Worth4 spot examination, stereoscopic vision, strabismus angle, accommodative convergence to accommodation ratio (AC/A), far and near positive and negative convergence, positive and negative fusion range, positive and negative relative accommodation. Clinical efficacy was evaluated at a period of 10mo follow-up. RESULTS: The distant and near stereopsis were found in 84.9% and 77.5% of patients in the BTXA-treated group, respectively. In the control group, all patients had distant and near stereopsis. The incidence of taking off one’s glasses to see close objects was significantly higher in the BTXA-treated group than in the control group (P<0.05). The BTXA-treated group showed a smaller range of in-fusion (9.84±5.72)° than the control group (22.04±8.71)° (P<0.05). The near esotropia angle of the BTXA-treated group (17.08±11.98)△ was significantly smaller than the distant esotropia angle (19.07±11.68)△ (P<0.05). Ten months after injection, the diplopia and esotropia of most patients underwent improvements after treatment (P<0.05). CONCLUSION: This study reveals that the accommodation function and the habit of near work without wearing spectacles are associated with near-work-related esotropia, while the length of time for near work and the onset time are independent of near-work-related esotropia. Additionally, BTXA injection therapy plays a vital role in relieving diplopia and restoring eye position.

Magnetic resonance imaging of extraocular rectus muscles abnormalities in acute acquired concomitant esotropia

“…To overcome binocular diplopia, the LR muscles of both eyes receive more nerve impulses and are thickened compensatorily. There are many treatment options for AACE [10,[33][34][35][36] . Previous research has suggested that strabismus surgery for AACE can successfully improve diplopia and restore good binocular function in patients who do not have underlying intracranial problems [37][38][39][40] .…”

“…Recently, the number of AACE subjects has been increased dramatically, but its pathogenesis remains unclear. According to previous studies, the risk factors of AACE was considered to be accommodative spasm, uncorrected myopia, intracranial diseases, excessive near work, and physical or psychic exhaustion [6][7][8][9][10][11][12] , all of which eventually caused an imbalance in the strength of the extraocular muscle (EOM) with an acute onset of esotropia. EOM maintains the eye position by balancing the strength of interacting muscles.…”

Development of a new 17-item Asthenopia Survey Questionnaire using Rasch analysis

“…The 11 th item (feel blur or ghosting when looking at distance objects) was not a valid measure of the construct and was eliminated in phase 2. It was shown that the asthenopic symptoms were often relieved when looking at distant objects due to the relaxation of accommodation and convergence [28] . In the last phase, participants with asthenopia and non-asthenopia were asked to finish ASQ-17 and it was confirmed that ASQ-17 could be the final version.…”