Acute acquired comitant esotropia of childhood: a classification based on 48 children

Published on Sep 1, 2015in Acta Ophthalmologica3.761
· DOI :10.1111/AOS.12730
Helena Buch10
Estimated H-index: 10
,
Troels Vinding11
Estimated H-index: 11
Sources
Abstract
Purpose To identify characteristics of pediatric patients who develop acute acquired comitant esotropia (AACE) with and without intracranial disease. Methods We reviewed the charts of 48 children consecutively referred to the hospital with AACE during a 13-year period. Inclusion criteria were acute onset of comitant esotropia, available data on ophthalmologic, orthoptic and neurologic examinations. Children with neurological signs, AACE recurrence or hyperopia <+3 dioptres (D) underwent brain computed tomography or magnetic resonance imaging. Patients without imaging were followed. Results In all, 48 cases were recorded. The mean age at onset was 4.7 years, being significantly higher among children with intracranial disease. Seven cause-specific types of AACE in childhood were identified: The acute accommodative (n = 15, 31%), decompensated monofixation syndrome or esophoria (n = 13, 27%), idiopathic (n = 9, 19%), intracranial disease (n = 3, 6%), occlusion related (n = 3, 6%), AACE secondary to different aetiologic disease (n = 3, 6%) and cyclic AACE (n = 2, 4%). Intracranial disease included hydrocephalus, pontine and thalamic glioma. Of the children with intracranial disease, 2 of 3 had no obvious neurological signs at onset. Four significant risk factors for intracranial disease were identified as follows: larger esodeviation at distance, recurrence of AACE, neuro signs (papilledema) and older age at onset (>6 years). Conclusion In a large case series of children with AACE and by review of literature, we identified seven cause-specific types of AACE. Intracranial disease was present in 6%, and four risk factors were identified to guide clinicians when to perform brain imaging. Findings suggest AACE of childhood to be differentiated from AACE of adulthood.
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References33
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#1Tracy B. Høeg (UCPH: University of Copenhagen)H-Index: 5
#2Birgitte MoldowH-Index: 8
Last. Helena Buch (UCPH: University of Copenhagen)H-Index: 10
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Purpose To determine the prevalence of amblyopia in Denmark before and after the initiation of the Danish national preschool vision screening programme. Methods In a population-based cross-sectional study, 3826 participants of the Danish General Suburban Population Study (GESUS) aged 20 years and older from a Danish rural municipality received a complete general health examination and an ophthalmological interview and examination. This study included a comprehensive ophthalmologic interview, mea...
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#1Erin P. Herlihy (Seattle Children's)H-Index: 6
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Importance Esotropia greater at distance than at near can be related to abducens palsy or to divergence insufficiency. Mild abduction weakness can be difficult to detect, blurring the distinction between these 2 conditions. Objectives To examine the clinical and eye movement findings that distinguish abducens palsy from divergence insufficiency and to account for these findings based on current knowledge of vergence neurophysiology and saccadic adaptation. Design Retrospective medical record rev...
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This is an observational case series of five cases of acute acquired comitant esotropia (AACE) with diplopia, aged between 5 and 12 years. The duration of presenting complaints ranged from 4 days to 2 months. A detailed ophthalmic evaluation and neuroimaging were done on all patients. Three patients were found to have intracranial pathology. Two patients had pontine glioma and one patient had benign intracranial hypertension. One patient was diagnosed as accommodative spasm and one patient was d...
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#1Veit Sturm (UZH: University of Zurich)H-Index: 16
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#1T. VindingH-Index: 1
#2E. GregersenH-Index: 1
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Abstract An epidemiological study of amblyopia was performed among old people without previous screening and treatment. The study revealed a prevalence of 2.9% (strabismic in 2.3%, anisometropic in 0.6%). Present residual amblyopia among Danish school children is about 1% according to literature. The rate of cure of amblyopia by the present Danish system of prophylaxis and treatment is estimated to be 60–70%.
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#1Abraham Spierer (Sheba Medical Center)H-Index: 21
Abstract Purpose To identify the characteristics of adult patients who develop acute concomitant esotropia of adulthood. Design Retrospective noncomparative case series. Participants Ten patients were included in this study. Intervention The charts of all adults with acute-onset concomitant esotropia who were examined at our institute between 1990 and 1997 were reviewed, and those who had developed the syndrome when they were older than the age of 16 years were included in this study. All partic...
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