title: Unusual presentations of accommodative esotropia.
abstract: OBJECTIVE
  Most patients with accommodative esotropia are first examined between the ages of 6 months and 2 years. This paper discusses unusual presentations of accommodative esotropia that occur outside of this age-group and/or have a precipitating event that triggered the esotropia. In a series of patients who were from 5 to 11 years of age, trauma was the precipitating event. In some of the patients under 6 months of age, high myopia, as well as a moderate to large amount of hyperopia, was the cause. In 1 teenager, diabetic ketoacidosis precipitated accommodative esotropia.
  
  
  METHODS
  We reviewed all of our records for the past 25 years involving patients with a diagnosis of esotropia, and we found 17 patients who had unusual presentations of accommodative esotropia. Of 8 who were under the age of 6 months, 2 had high myopia and 6 had moderate to large amounts of hyperopia. Nine patients were older than age 5. Eight of the 9 had suffered trauma associated with the presentation of accommodative esotropia, and 1 patient's accommodative esotropia was associated with diabetes. The patients with myopia received their full myopic correction. The children under 6 months of age with hyperopia received their full cycloplegic refraction, and the children over age 5 received the most plus that they were able to accept in a noncycloplegic state consistent with good visual acuity (at least 20/30 in each eye).
  
  
  RESULTS
  In 17 patients, accommodative esotropia was initially controlled with glasses. In a few of the trauma cases, bifocals were required for control of near deviation. Only 2 of the patients, in whom onset was under 6 months of age, came to surgery. One had hyperopia controlled for 2 years with glasses, and the other had myopia controlled for 3 years with glasses.
  
  
  CONCLUSIONS
  Accommodative esotropia can occur prior to 6 months of age. It can also occur in older children (5 to 14 years of age) and can be precipitated by trauma or diabetic ketoacidosis.
authors.affiliation: Department of Ophthalmology, Scottish Rite Children's Medical Center, Atlanta, USA.
authors.forename: Z F
authors.initials: ZF
authors.lastname: Pollard
authors.forename: M F
authors.initials: MF
authors.lastname: Greenberg
mesh_terms: D000065:Accommodation, Ocular; D002648:Child; D002675:Child, Preschool; D016883:Diabetic Ketoacidosis / Q000150:complications; D004948:Esotropia / Q000209:etiology / Q000503:physiopathology* / Q000628:therapy*; D005131:Eye Injuries / Q000150:complications; D005139:Eyeglasses; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006956:Hyperopia / Q000150:complications; D007223:Infant; D008297:Male; D009216:Myopia / Q000150:complications; D013508:Ophthalmologic Surgical Procedures; D012189:Retrospective Studies; D014792:Visual Acuity