Topical Cycloplegics Show Promise in Treating Acute Acquired Comitant Esotropia

Topical cycloplegics appear to be a promising treatment for patients with acute acquired comitant esotropia resulting from excessive smartphone use (SAACE), according to a study published in BMC Ophthalmology. Patients who go untreated for longer time periods, however, are less likely to experience positive outcomes.

Researchers enrolled 23 participants with SAACE that remained untreated for over 1 year in a study and stratified them according to their willingness to receive 0.4% tropicamide drops on a nightly basis. Those who consented comprised the treatment group (n=14; mean age, 22.6 years) while those who refused were enrolled in the control group (n=9, mean age, 25.0 years). Patients underwent esotropia angle and stereoacuity measurements at baseline and 3 months. Participants limited device use during the study duration and diplopia improvements were assessed during the follow-up visit.

Investigators report esotropia angles decreased and stereoacuity improved after 3 months in the treatment group compared with control group participants (both P <.01). Diplopia resolved in 13 treatment group patients (92.9%) either with (n=9) or without (n=4) the use of spectacle lenses containing built in prisms. 

Diplopia did not resolve in any control group participants and 7 participants elected to have surgery. Esotropia angles were higher among these participants compared with both treatment group (P <.001) and control group patients. These participants also exhibited better stereoacuity compared with control individuals, according to the report.  

A subanalysis of 11 patients with untreated esotropia revealed that a decrease in esotropia angle correlated with untreated esotropia duration (near: R=-0.6; distance: R=0.7; both P <.05). No association between esotropia angle decrease and refractive error was established.  

“In addition to limiting digital device usage, topical cycloplegics appear to be a promising treatment for acute esotropia induced by excessive usage of digital devices,” according to the researchers. “However, these treatments are less effective in patients with longer untreated periods. Therefore, early diagnosis and treatment are important in these types of patients.”

Study limitations include a small sample size, self-reporting of digital use data, failure to isolate the treatment effects of the digital device and 0.4% tropicamide use, and a lack of randomization.