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. 2022 Apr;70(4):1359-1364.
doi: 10.4103/ijo.IJO_2813_21.

Acute acquired comitant esotropia precipitated by excessive near work during the COVID-19-induced home confinement

R Neena  1 , S Remya  2 , Giridhar Anantharaman  3
Affiliations

Acute acquired comitant esotropia precipitated by excessive near work during the COVID-19-induced home confinement

R Neena et al. Indian J Ophthalmol. 2022 Apr.

Abstract

Purpose: To evaluate the causes of acute acquired comitant esotropia (AACE) in young adults and children in the setting of COVID-19-induced home confinement.

Methods: A retrospective, clinical study of all patients, who presented to the Pediatric Ophthalmology and Strabismus services of a tertiary eye care center in South India from August 2020 to January 2021 during the COVID-19 pandemic, with acute-onset, comitant esotropia.

Results: 11 (73.3%) of the total 15 patients were students, above 10 years and with a mean age of 16.8 years. 12 patients (80%) had more than 8 hours of near activity a day with a mean duration of 8.6 hours per day. The most common near activity was online classes, followed by job-related work and mobile games, and 86.7% used smartphones for near work. The average esotropia was 22.73 prism diopter (PD) for distance and 18.73 PD for near. Majority (66.6%) had hyperopia with basic or divergence insufficiency esotropia, and the remaining 33.3% had myopia and fitted in to the Bielschowsky type AACE. There was no precipitating event other than sustained near work in all, except in one patient who also had fever prior to the onset of esotropia.

Conclusion: The habit of long-time and sustained near work, especially on smartphones, may increase the risk of inducement of AACE.

Keywords: AACE; COVID-19; excess near work.

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Conflict of interest statement

None

Figures

Figure 1
Figure 1
(a) Patient A at 1.5 years. (b) Patient A (an avid PUBG video game player) before and after surgery
Figure 2
Figure 2
(a) Patient B 6 months before with straight eyes (b) Patient B (Class X student with 8 hours/day of online classes on smartphone) with basic type esotropia (left eye) before and after surgery
Figure 3
Figure 3
(a) Patient C (using smartphone for online classes and games more than 8 hours/day) showing basic type esotropia (right eye), (b) Patient C showing straight eyes post right eye surgery (medial rectus recession + lateral rectus resection)
Figure 4
Figure 4
(a) Patient D before: 17 years old, college student who developed AACE with more than 8 hours of near work on smartphone; (b) Patient D after surgery (medial rectus recession + lateral rectus resection)
See this image and copyright information in PMC

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