Progression of acute comitant esotropia into cyclical esotropia in a 7-year-old child.

Abstract

We report the case of a 7-year-old girl who, following prolonged screen exposure, developed acute comitant esotropia, which progressed within 1 month to a cyclical pattern. For 4 months the cycles followed a 48-hour pattern, afterward progressing to episodes of esotropia lasting interspersed with a day of orthophoria, for another 2 months. Subsequently, the patient developed suppression and constant esotropia. Once the strabismus angles stabilized and remained reproducible, she underwent a 5.5 mm bilateral medial rectus recession. Postoperatively, she achieved orthophoria with restored binocularity and full stereopsis for both distance and near. Acute comitant esotropia is a well-documented condition associated with excessive screen time and near activities, typically presenting with diplopia beyond infancy. Cyclical esotropia, a rare form of strabismus, follows a pattern of alternating esotropia and orthophoria, with cycles ranging from 48 hours to several days.