Letter to the Editor: Environmentally Driven Abnormalities in Accommodation and Vergence Can Be One of the Causes of Acute Acquired Comitant Esotropia

Neurological pathologies in acute acquired comitant esotropia

“…The results revealed that AACE with unclear etiologies can occur in many cases in both children and adults [ 1 , 2 , 6 , 8 , 14 – 18 ]. Functional etiological factors for AACE were found to be due to many reasons, such as functional accommodative spasm [ 8 , 19 ], the excessive near work use of mobile phones/smartphones, and other digital screens [ 5 , 11 , 12 , 20 – 24 , 73 ]. For example, the rise of AACE has been witnessed during the coronavirus disease 2019 (COVID-19) pandemic when people were forced to stay at home and work from home through digital devices [ 23 , 24 ].…”

To prioritize treatment options for acute acquired comitant esotropia

“…Acute acquired comitant esotropia (AACE) is an uncommon subtype of esotropia characterized by sudden and usually late onset of a relatively large angle of comitant esotropia with diplopia in older children and adults. [1][2][3][4] First, the author recommends that patients with acute onset diplopia and comitant esotropia should go through comprehensive ophthalmological and neurological examinations (e.g., neuroimaging), and the assessment of methodical medical records to rule out several potential causes, such as cyclic esotropia, divergence insufficiency, paretic strabismus, and myasthenia gravis. 1,3 Environmental factors (e.g., the excessive near work use of mobile phones/smartphones and other digital screens) should also be addressed before any treatment, as a decrease in the degree of esodeviation after refraining from mobile phone/smartphone use has been reported.…”

“…1,3 Environmental factors (e.g., the excessive near work use of mobile phones/smartphones and other digital screens) should also be addressed before any treatment, as a decrease in the degree of esodeviation after refraining from mobile phone/smartphone use has been reported. 2,4 The author's experience suggests that spontaneous improvement of deviation in AACE is unusual. 1 However, the prognosis of gaining good binocularity is good in patients with AACE via nonsurgical and surgical treatment options.…”

“…1 Although esotropia does not resolve with the correction of refractive error in most patients with AACE, it is important for all patients to be fully corrected before starting any additional treatment, according to the experience of the author. 1,2 Cycloplegic refraction should be performed to exclude the presence of an accommodative component, particularly in young patients. 1,2 Ocular occlusion is recommended to manage diplopia if it is not contraindicated for some reason.…”

“…1,2 Cycloplegic refraction should be performed to exclude the presence of an accommodative component, particularly in young patients. 1,2 Ocular occlusion is recommended to manage diplopia if it is not contraindicated for some reason. 1,2 Ocular occlusion can also be applied while the patient is going through several vital neurological and ocular examinations.…”