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Case Reports
. 2023 Sep 26;11(27):6476-6482.
doi: 10.12998/wjcc.v11.i27.6476.

Acute acquired concomitant esotropia with congenital paralytic strabismus: A case report

Meng-Di Zhang  1 , Xiang-Yu Liu  1 , Ke Sun  2 , Shou-Nan Qi  1 , Chun-Ling Xu  3
Affiliations
Case Reports

Acute acquired concomitant esotropia with congenital paralytic strabismus: A case report

Meng-Di Zhang et al. World J Clin Cases. .

Abstract

Background: An unusual case of acute acquired concomitant esotropia (AACE) with congenital paralytic strabismus in the right eye is reported.

Case summary: A 23-year-old woman presented with complaints of binocular diplopia and esotropia of the right eye lasting 4 years and head tilt to the left since 1 year after birth. The Bielschowsky head tilt test showed right hypertropia on a right head tilt. She did not report any other intracranial pathology. A diagnosis of AACE and right congenital paralytic strabismus was made. Then, she underwent medial rectus muscle recession and lateral rectus muscle resection combined with inferior oblique muscle myectomy in the right eye. One day after surgery, the patient reported that she had no diplopia at either distance or near fixation and was found to be orthophoric in the primary position; furthermore, her head posture immediately and markedly improved.

Conclusion: In future clinical work, in cases of AACE combined with other types of strabismus, we can perform conventional single surgery for both at the same time, and the two types of strabismus can be solved simultaneously.

Keywords: Acute acquired concomitant esotropia; Case report; Congenital paralytic strabismus; Simultaneous surgery; Superior oblique paralysis.

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Conflict of interest statement

Conflict-of-interest statement: All the authors declare that they have no conflicts of interest to disclose.

Figures

Figure 1
Figure 1
Preoperative nine-gaze image. A: Normal eye movement in gaze up-and-right; B: Normal eye movement in upgaze; C: Overaction of the inferior oblique muscle in the right eye; D: Normal eye movement in right gaze; E: Esotropia of the right eye in the primary position; F: Overaction of the inferior oblique muscle in the right eye; G: Normal eye movement in gaze down-and-right; H: Normal eye movement in downgaze; I: Underaction of the superior oblique muscle in the right eye.
Figure 2
Figure 2
Preoperative Bielschowsky head tilt test and fundus photography. A: Bielschowsky head tilt test showing right hypertropia worse with right head tilt; B and C: Preoperative fundus photography showing a normal fovea-disc relative position in the right (B) and left (C) eyes.
Figure 3
Figure 3
Postoperative nine-gaze image 1 wk after surgery. A: Normal eye movement in gaze up-and-right; B: Normal eye movement in upgaze; C: Improved inferior oblique overaction in the right eye; D: Normal eye movement in right gaze; E: Orthophoria in the primary position; F: Improved inferior oblique overaction in the right eye; G: Normal eye movement in gaze down-and-right; H: Normal eye movement in downgaze. I: Improved superior oblique underaction in the right eye.
Figure 4
Figure 4
Postoperative Bielschowsky head tilt test and fundus photography 1 wk after surgery. A: Bielschowsky head tilt test showing negative results; B and C: Postoperative fundus photography showing a normal fovea-disc relative position in the right (B) and left (C) eyes.
See this image and copyright information in PMC

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