Acute acquired comitant esotropia: a prospective study

Purpose To define the clinical characteristics of patients presenting with acute onset esotropia and features suggestive of possible underlying centra l nervous system pathology. To assess the prognosis for the return of binoc ular function and to consider the most appropriate management. Methods A prospective clinical study was carried out of all patients presen ting to the department of paediatric ophthalmology at a university teaching hospital over the period January 1994 to April 1997. Each patient underwen t a full ophthalmological examination (including assessment of sensory stat us). All patients were referred to a paediatric neurologist: for examinatio n and CT and/or MRI scan. Results Ten patients presented during the study period. Uncorrected hyperme tropia and/or decompensated monofixation syndrome were the commonest aetiol ogical factors. One patient was found to have a cerebellar tumour. In 5 pat ients prescription of the full hypermetropic correction alone was sufficien t to restore binocularity. Five patients required bilateral medial rectus r ecession. Binocular function was restored in all cases - in 5 cases with bi foveal fusion. Conclusion Decompensation of a pre-existing phoria or monofixation syndrome appears the commonest aetiology. Prescription of the full hypermetropic co rrection found at cycloplegic refraction forms an essential part of initial management. No single clinical sign can reliably indicate the rare patient harbouring a tumour. A high index of suspicion should be maintained and ne uro-imaging considered in the absence of expected findings such as hypermet ropia or fusion potential or in the presence of atypical features or neurol ogical signs.