Adult-Onset Comitant Esotropia: Patient Characteristics and Medical Evaluation

Abstract

Purpose: To categorize the demographics, clinical profile, and medical work-up findings in adult-onset comitant esotropia (AOCET). Methods: The authors conducted a retrospective study of adult patients with AOCET and without a history of childhood strabismus, prior strabismus surgery, ocular trauma, recent concussion, other neurologic symptoms excluding diplopia, duction deficit, or evidence of sixth cranial nerve palsy. Patients were analyzed by age of onset and refractive error. Results: Two hundred sixty-eight patients were included, for which the mean age was 53.7 ± 19.3 years. There were more women (62.7%) than men (37.3%) overall and in every age decade. The mean refractive error was -3.22 ± 3.84 diopters, with myopia being prevalent in the younger decades, whereas the proportion of hypermetropia increased as age of onset increased. The overall mean distance esotropia was 17.2 ± 13.1 prism diopters, and was seen in an inverse relationship pattern with higher mean esotropia in the younger cohorts and lower mean esotropia in older patients. An etiology for esotropia was identified in 18 of 268 (6.7%) but only revealed new diagnoses for 6 patients: 4 thyroid eye disease, 1 myasthenia gravis, and 1 multiple sclerosis. Conclusions: The study revealed a predominantly female, White, and myopic cohort. Testing for thyroid eye disease, myasthenia gravis, and neuroimaging rarely found an underlying medical cause for AOCET.