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. 2025 Feb 27;55(1):6-10.
doi: 10.4274/tjo.galenos.2024.68745.

Clinical Characteristics and Analysis of Spontaneous Consecutive Exotropia in Children with Refractive Accommodative Esotropia

Aysel Pelit  1 , Nazife Sefi Yurdakul  2
Affiliations

Clinical Characteristics and Analysis of Spontaneous Consecutive Exotropia in Children with Refractive Accommodative Esotropia

Aysel Pelit et al. Turk J Ophthalmol. .

Abstract
in English, Turkish

Objectives: To assess the clinical characteristics and risk factors associated with spontaneous consecutive exotropia (ScXT) in children diagnosed with refractive accommodative esotropia (RAET).

Materials and methods: A retrospective analysis of medical records was conducted on 19 patients who demonstrated a spontaneous transition from RAET to exotropia (XT). Patients who received strabismus surgery or botulinum toxin injection were excluded from the study. The control group consisted of 31 age-matched patients with RAET who demonstrated successful optical alignment at both near and distance. The ophthalmological examination findings of the study and control groups were compared. Independent two-sample t-test and Pearson's chi-square test were used to evaluate the data of the patients.

Results: The study examined patients diagnosed with RAET who developed consecutive XT. Among them, 15 (78.9%) were female and 4 (21.1%) were male. The mean age at esotropia (ET) onset was 22.68 months (standard deviation [SD]: 12.91). The control group consisted of 16 (51.6%) female and 15 (48.4%) male patients, with a mean age at ET onset of 25.09 months (SD: 15.47). Mean age at onset did not differ between the groups (p=0.55). The mean interval between ET onset and appearance of XT was 7.53 years (SD: 1.49). Cycloplegic refraction measurements taken during the initial examination indicated that the study group exhibited greater degrees of hypermetropia in their right (p=0.01) and left (p=0.04) eyes than did the control group. Furthermore, the incidence of inferior oblique muscle overaction was higher among the study group (p=0.03).

Conclusion: The findings indicate that patients with high hypermetropic refraction values should be monitored for an extended period due to the increased risk of developing subsequent XT. Concomitant inferior oblique overaction can increase the risk of ScXT.

Amaç: Refraktif akomodatif ezotropya (RAET) tanısı alıp spontan ardıl ekzotropya (SAXT) gelişen çocuklarda klinik özellikleri ve risk faktörlerini değerlendirmek.

Gereç ve Yöntem: RAET’den ekzotropyaya (XT) spontan geçiş gösteren 19 hastanın tıbbi kayıtlarının retrospektif bir analizi yapıldı. Şaşılık cerrahisi veya botulinum toksin enjeksiyonu yapılan hastalar çalışma dışı bırakıldı. Kontrol grubu, RAET’si olan, yaş açısından eşleştirilmiş, hem yakın hem de uzakta gözlük ile kaymanın düzeldiği 31 hastadan oluşmuştur. Çalışma ve kontrol gruplarının oftalmolojik muayene bulguları karşılaştırıldı. Hastaların verilerini değerlendirmek için bağımsız örneklem t-testi ve Pearson ki-kare testi kullanıldı.

Bulgular: Çalışmada RAET tanısı konan ve ardıl XT gelişen hastalar incelendi. Hastaların 15’i (%78,9) kadın, 4’ü (%21,1) erkekti. Ortalama ezotropya (ET) başlangıç yaşı 22,68 ay (standart deviasyon [SD]: 12,91) idi. Kontrol grubu 16 (%51,6) kadın ve 15 (%48,4) erkek hastadan oluşmaktaydı ve ortalama ET başlangıç yaşı 25,09 aydı (SD: 15,47). İki grup arasında ortalama başlangıç yaşı açısından istatistiksel olarak anlamlı bir fark tespit edilmedi (p=0,55). ET’nin başlangıcı ile XT’nin ortaya çıkışı arasındaki ortalama süre 7,53 yıldı (SD: 1,49). İlk muayene sırasında alınan sikloplejik refraksiyon ölçümleri, çalışma grubunun sağ (p=0,01) ve sol (p=0,04) gözlerinde kontrol grubuna göre daha yüksek hipermetropi olduğunu göstermiştir. Ayrıca, alt oblik hiperfonksiyonu insidansı çalışma grubunda daha yüksekti (p=0,03).

Sonuç: Çalışmanın bulguları, yüksek hipermetropik refraksiyon değerlerine sahip hastaların, XT gelişme riskinin yüksek olması nedeniyle uzun süre izlenmesi gerektiğini göstermektedir. Eşlik eden alt oblik hiperfonksiyonu SAXT riskini artırabilir.

Keywords: Spontaneous consecutive exotropia; hypermetropia; inferior oblique overaction; refractive accommodative esotropia.

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Conflict of interest statement

Conflict of Interest: No conflict of interest was declared by the authors.

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