Evaluation and surgical outcome of acquired nonaccommodative esotropia among older children.

OBJECTIVE

To describe the presentation, clinical evaluation, work-up, surgical management, and surgical outcomes in children older than 8 years with spontaneous, comitant, acquired nonaccommodative esotropia (ANAET).

DESIGN

Retrospective chart review.

PARTICIPANTS

Children who underwent bilateral medial rectus recession surgery for ANAET with initial esotropia onset later than 8 years of age.

METHODS

The medical records of children older than 8 years presenting with ANAET from 2009 to 2015 were retrospectively reviewed. The clinical presentation, work-up, surgical intervention, preoperative and postoperative deviations, and surgical outcomes were recorded.

RESULTS

A total of 7 healthy patients were identified. The average age of onset was 11.9 years. All patients presented with symptoms of diplopia with large-angle esotropia. Most patients had no preceding illness and presented with minimal refractive error. All 7 patients had unremarkable neurological and general pediatric evaluations without findings of acute intracranial pathology on neuroimaging. Bilateral medial recession surgery was performed for all 7 patients with resolution of diplopia and excellent stereopsis postoperatively.

CONCLUSIONS

Diplopia is the most common presenting symptom among older children presenting with ANAET. Bilateral medial recession surgery achieved excellent postoperative results with resolution of diplopia and excellent stereopsis.