Neurological pathologies in acute acquired comitant esotropia

Graefes Arch Clin Exp Ophthalmol. 2023 Dec;261(12):3347-3354. doi: 10.1007/s00417-023-06092-3. Epub 2023 May 5.


Background: Acute acquired comitant esotropia (AACE) is an uncommon subtype of esotropia characterized by sudden and usually late onset of a relatively large angle of comitant esotropia with diplopia in older children and adults.

Methods: A literature survey regarding neurological pathologies in AACE was conducted using databases (PubMed, MEDLINE, EMBASE, BioMed Central, the Cochrane Library, and Web of Science) in order to collect data for a narrative review of published reports and available literature.

Results: The results of the literature survey were analyzed to provide an overview of the current knowledge of neurological pathologies in AACE. The results revealed that AACE with unclear etiologies can occur in many cases in both children and adults. Functional etiological factors for AACE were found to be due to many reasons, such as functional accommodative spasm, the excessive near work use of mobile phones/smartphones, and other digital screens. In addition, AACE was found to be associated with neurological disorders, such as astrocytoma of the corpus callosum, medulloblastoma, tumors of the brain stem or cerebellum, Arnold-Chiari malformation, cerebellar astrocytoma, Chiari 1 malformation, idiopathic intracranial hypertension, pontine glioma, cerebellar ataxia, thalamic lesions, myasthenia gravis, certain types of seizures, and hydrocephalus.

Conclusions: Previously reported cases of AACE with unknown etiologies have been reported in both children and adults. However, AACE can be associated with neurological disorders that require neuroimaging probes. The author recommends that clinicians should perform comprehensive neurological assessments to rule out neurological pathologies in AACE, especially in the presence of nystagmus or abnormal ocular and neurological indications (e.g., headache, cerebellar imbalance, weakness, nystagmus, papilloedema, clumsiness, and poor motor coordination).

Keywords: Acute acquired comitant esotropia; Arnold-Chiari malformation; Hydrocephalus; Intracranial tumors; Neurological pathologies; Strabismus.

Publication types

  • Review

MeSH terms

  • Acute Disease
  • Adult
  • Arnold-Chiari Malformation* / complications
  • Astrocytoma* / complications
  • Child
  • Esotropia* / complications
  • Esotropia* / etiology
  • Eye
  • Headache
  • Humans
  • Retrospective Studies