Acute Acquired Comitant Esotropia in Adults: Is It Neurologic or Not?

Table 1

Clinical characteristics of patients with acute acquired comitant esotropia.

Patient number	Sex	Age (years)	Duration of symptoms	Presenting complaint	Sign	Vision		Deviation (PD)		Neurological examination	Investigations	Treatment	Surgical intervention	Prism glasses	Follow-up (years)	Outcome
						RE	LE	D	N
1	M	32	6 months	Diplopia	Right esotropia	1.0	1.0	40	40	Normal	Cranial and orbital MRI: normal; Tensilon test: negative	Surgery	RE MR Rc 5.5 mm, RE LR Re 6.5 mm	—	8	No manifest deviation
2	M	29	10 months	Diplopia	Right esotropia	1.0	1.0	18	16	Normal	Cranial and orbital MRI: normal; Tensilon test: negative	Prism	—	16 PD BO; Ground-in; Both eyes	9	No manifest deviation with prism
3	M	43	12 months	Diplopia	Left esotropia	1.0	1.0	35	40	Normal	Cranial and orbital MRI: normal; Single fiber EMG: negative; Acetylcholine receptor ab: negative	Botulinum toxin injections	—	—	2	No manifest deviation after botulinum toxin injections
4	M	23	4 months	Diplopia	Right esotropia	1.0	1.0	45	45	Normal	Cranial and orbital MRI: normal; Single fiber EMG: negative; Acetylcholine receptor ab: negative	Refused any treatment	—	—	2	No change
5	F	43	18 months	Diplopia	Left esotropia	1.0	1.0	30	25	Normal	Cranial and orbital MRI: normal; Single fiber EMG: negative	Surgery	LE MR Rc 5.0 mm, LE LR Re 5.5 mm	—	6	Intermittent; 6 pd left esotropia
6	F	20	15 days	Diplopia; Headache	Right esotropia	1.0	1.0	20	20	Normal	Cranial and orbital MRI: simple pineal cyst; Cranial MR angiography: normal; Single fiber EMG: negative	Prism	—	20 PD BO; Ground-in; Both eyes	4	No manifest deviation with prism
7	F	22	1 months	Diplopia	Left esotropia	1.0	1.0	25	25	Normal	Cranial and orbital MRI: normal; Tensilon test: negative	Surgery	LE MR Rc 4.0 mm, LE LR Re 5.5 mm	—	3	No manifest deviation
8	F	32	6 months	Diplopia	Left esotropia	1.0	1.0	16	18	Normal	Cranial and orbital MRI: normal; Tensilon test: negative; Acetylcholine receptor ab: negative	Prism	—	16 PD BO; Ground-in; Both eyes	2	No manifest deviation with prism
9	F	27	10 days	Diplopia	Left esotropia	1.0	1.0	40	35	Normal	Cranial and orbital MRI: normal; Single fiber EMG: negative	Surgery	LE MR Rc 5.5 mm, LE LR Re 6.5 mm	—	1	No manifest deviation

F: female, M: male, RE: right eye, LE: left eye, PD: prism diopters, D: distance, N: near, MRI: magnetic resonance imaging, EMG: electromyography, ab: antibody, MR: medial rectus, LR: lateral rectus, Rc: recession, Re: resection, and BO: base-out.