Acute acquired concomitant esotropia associated with myopia: is the condition related to any binocular function failure?
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Acute acquired concomitant esotropia associated with myopia: is the condition related to any binocular function failure? Celeste Ruatta 1
&
Costantino Schiavi 1
Received: 19 April 2020 / Revised: 17 June 2020 / Accepted: 25 June 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Purpose To evaluate the sensory motor state, accommodation, and accommodative convergence to accommodation ratio (AC/A) in a cohort of non-amblyopic myopes with acquired concomitant esotropia (Bielschowsky esotropia (BE)). Methods Refraction, near and far deviation, fusional amplitude (FA), near point of accommodation (NPA), AC/A (gradient method), and stereopsis were measured in a cohort of 26 patients (25 phakic and 1 pseudophakic, age: 14–60 years) with BE, prospectively recruited from January to September 2019 at St. Orsola-Malpighi Hospital, Bologna, Italy. The Pearson’s correlation coefficient was used to correlate distance with near deviation, distance with near divergence FA and angle of deviation with FA (statistical significance: p values < 0.05). Results Myopia range was 0–17.5 diopters (D) spherical equivalent (mean: 4.4 D). A positive correlation resulted between distance (mean: 23.7 prism diopters/PD, range: 4–40 PD) and near (mean: 23.7 PD, range: 2–45 PD) deviation (p < 0.00001) and between distance (mean: 12.6 PD, range 0–34 PD) and near (mean: 17.0 PD, range 3–36 PD) divergence FA (p < 0.00001). A nonsignificant correlation resulted between angle of deviation and divergent FA at near (p = 0.07) and distance (p = 0.13) fixation. NPA was within normal limits for age. AC/C ratio range was 0–8 (mean: 3). Twenty-three patients showed Randot stereopsis. Conclusions BE shows high variability in the age of onset, degree of associated myopia, AC/A, and divergent FA. A little stronger near divergent FA can justify the better compensation at near fixation. These results show that uncorrected myopia, accommodation, and divergence paralysis do not concur with the genesis of BE. Keywords Acute acquired concomitant esotropia . Distance esotropia . Adult esotropia . Bielschowsky concomitant esotropia . Myopia . Horizontal diplopia
Introduction Acute acquired concomitant esotropia (AACE) is a rare presentation of esotropia which occurs in children, adults, and even the elderlies [1]. Three main types have been defined by Burian and Miller in 1958: (1) swan type: concomitant esotropia due to the disruption of fusion precipitated by monocular occlusion or loss of vision in one eye in infants or children [2]; (2) Burian-Franceschetti type: concomitant esotropia characterized by minimal hypermetropia and diplopia, which is often associated with physical or psychological * Celeste Ruatta [email protected] 1
University Eye Clinic, St. Orsola-Malpighi Teaching Hospital, Department of Experimental, Diagnostic and Specialty Medicine – DIMES, University of Bologna, Bologna, Italy
stress in teenagers and young patients; (3) Bielschowsky type: concomitant esotropia which can arise from adolescence to
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