Acute Acquired Comitant Esotropia in Adults: Is It Neurologic or Not?
BACKGROUND To describe the clinical characteristics and outcomes of acute acquired comitant esotropia (AACE) related to excessive smartphone use in adolescents. METHODS The medical records of 12 patients with AACE and a history of excessive smartphone use were retrospectively reviewed, and the duration of smartphone use, angle of deviation, refractive error, stereopsis, and treatment options were analyzed. RESULTS All patients showed convergent and comitant esotropia ranging from 15 to 45 prism diopters (PD; average: 27.75 ± 11.47 PD) at far fixation. The angle of deviation was nearly equivalent for far and near fixation. Every patient used a smartphone for more than 4 h a day over a period of several months (minimum 4 months). Myopic refractive errors were detected in eight patients (average:-3.84 ± 1.68 diopters (D]), and the remaining four patients showed mild hyperopic refractive error (average: +0.84 ± 0.53 D). Reductions in esodeviation were noted in all patients after refraining from smartphone use, and bilateral medial rectus recession was performed in three patients with considerable remnant esodeviation. Postoperative exams showed orthophoria with good stereoacuity in these patients. CONCLUSION Excessive smartphone use might influence AACE development in adolescents. Refraining from smartphone use can decrease the degree of esodeviation in these patients, and remnant deviation can be successfully managed with surgical correction.