Acquired nonaccommodative esotropia in childhood

Purpose: Acquired nonaccommodative esotropia (ANAET) in childhood is report ed to occur infrequently and is often associated with an underlying neurolo gic or neoplastic disorder. The primary objective of this study was to asce rtain the prevalence and clinical characteristics of this form of childhood esotropia. Methods: A cohort of all children younger than 11 years with es otropia from a predominantly rural Appalachian region was prospectively ide ntified from August 1, 1995, through July 31, 1998. The age at onset, famil y history of strabismus, perinatal and medical history, ophthalmologic find ings, and surgical results were reviewed for all patients with ANAET. Resul ts: Twenty-three (10.4%) of 221 consecutive children with esotropia were di agnosed with ANAET compared with 12 (5.4%) diagnosed with congenital esotro pia. The median age at esotropia onset for the 23 children with ANAET was 3 1.4 months (range, 8-63 months) with a mean initial angle of esotropia of 2 4 PD. Although at least 2 children presented with diplopia, none of the 23 patients were known to have harbored intracranial tumors or other lesions o f the central nervous system during the follow-up period. Fourteen of the 1 9 patients who underwent surgery attended follow-up visits for at least 6 m onths after their last surgical procedure: 13 were within 8 PD or less of o rthotropia, whereas the final patient had persistent esotropia. Twelve of t he 13 patients within 8 PD of orthotropia demonstrated some level of stereo psis, including 2 children with bifoveal fixation. Two (10.5%) of the 19 op erated patients later required a low hyperopic spectacle correction to cont rol their deviation. Conclusions: ANAET was more prevalent than congenital esotropia in this cohort of children with esotropia. This clinically distin ct form of strabismus typically begins between 1 and 5 years of age and app ears to be infrequently associated with underlying disease. The angle of de viation is relatively small and early surgical correction is more likely to achieve bifoveal fixation for these patients than for those with congenita l esotropia.