EC Ophthalmology

Significance: Due to increasing near-distance work and screen time, the prevalence of acute onset Esotropia (ET) is increasing among children. A non-invasive and effective method for restoring binocular vision is in demand in ophthalmology and optometry.

Purpose: We illustrate a new method with a combined application of low-energy laser and prism adaptation to restore binocular vision in an 11-year-old girl who developed acute acquired esotropia.

Case Report: An 11-year-old girl presented with her mother, noting her eyes had inward drifting. The cover test showed alternate esotropia, varied from 30D, equally in far and near distances. We applied fifteen sessions of prism exercise and anti-suppressive therapy with a low-energy laser. We encouraged her to do lateral rectus muscle exercises, as well. The treatment course resulted in the improvement of ET to mild esophoria. This finding was stable in the one-year follow-up; However, the esotropia rarely recures after physical and emotional stress.

Conclusion: There are various methods to manage acute onset esotropia. To improve brain plasticity and retrain the visual system to fuse the images from both eyes, we demonstrated that prism adaptation exercise combined with low-energy laser therapy is a practical approach. In addition, this treatment can be applied together with surgery or botulinum toxin injection to improve binocular vision and decrease the residual ET. To our knowledge, this case is the first reported esotropia managed by a combination of Low-energy laser and prism exercises.

Keywords: Acute Acquired Esotropia; Esotropia; Low-Energy Laser Treatment; Prism

1. Cai C., et al. “Clinical Characteristics and Surgical Outcomes of Acute Acquired Comitant Esotropia”. BMC Ophthalmology 19 (2019): 173.
2. Hess RF., et al. “A Binocular Approach to Treating Amblyopia: Antisuppression Therapy”. Optometry and Vision Science 87 (2010): 697-704.
3. Gilbert AL., et al. “Evaluation and Management of Acute Acquired Comitant Esotropia in Children. In: Seminars in Ophthalmology”. Taylor and Francis 32 (2017): 8-13.
4. Clark AC., et al. “Acute Acquired Comitant Esotropia”. British Journal of Ophthalmology 73 (1989): 636-638.
5. Mohan A., et al. “Series of Cases of Acute Acquired Comitant Esotropia in Children Associated with Excessive Online Classes on Smartphone During COVID-19 Pandemic; Digital Eye Strain Among Kids (DESK) study-3”. Strabismus 29 (2021): 163-167.
6. Van Hoolst E., et al. “Association Between Near Viewing and Acute Acquired Esotropia in Children During Tablet and Smartphone Use”. Strabismus 30 (2022): 59-64.
7. Lueder G., et al. “2018-2019 BCSC (Basic and Clinical Science Course), Section 06: Pediatric Ophthalmology and Strabismus (MAJOR REVISION). 2017. San Francisco, CA: American Academy of Ophthalmology”. San Franc CA Ame (2017).
8. Lee HJ and Kim SJ. “Clinical Characteristics and Surgical Outcomes of Adults with Acute Acquired Comitant Esotropia”. The Japanese Journal of Ophthalmology 63 (2019): 483-489.
9. Sengpiel F., et al. “Strabismic Suppression Is Mediated by Inhibitory Interactions in The Primary Visual cortex”. Cerebral Cortex 16 (2006): 1750-1758.
10. Lang L., et al. “Comparison of Botulinum Toxin with Surgery for the Treatment of Acute Acquired Comitant Esotropia and Its Clinical Characteristics”. Scientific Reports 9 (2019): 1-6.
11. Ivandic BT and Ivandic T. “Low-Level Laser Therapy Improves Visual Acuity in Adolescent and Adult Patients with Amblyopia”. Photomedicine and Laser Surgery 30 (2012): 167-171.
12. Guzun OV., et al. “Laser Stimulation of Retina and Optic Nerve in Children with Anisometropic Amblyopia”. In: 2019 IEEE 8th International Conference on Advanced Optoelectronics and Lasers (CAOL) (2019): 1-5.
13. Agrawal S., et al. “Nonsurgical Treatment of Strabismus”. In: Agrawal S, ed. Strabismus: For Every Ophthalmologist. Singapore: Springer (2019): 101-14.
14. Pisella L., et al. “Prism Adaptation in The Rehabilitation of Patients with Visuo-Spatial Cognitive Disorders”. Current Opinion in Neurology 19 (2006): 534-542.
15. Ohtsuki H., et al. “Preoperative Prism Correction in Patients with Acquired Esotropia”. Graefe's Archive for Clinical and Experimental Ophthalmology 231 (1993): 71-75.
16. Zhang P., et al. “Comparison of The Therapeutic Effects of Surgery Following Prism Adaptation Test Versus Surgery Alone in Acute Acquired Comitant Esotropia”. BMC Ophthalmology 20 (2020): 303.