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.