title: Acute adult onset comitant esotropia associated with accommodative spasm.
abstract: OBJECTIVE
  Acute onset comitant esotropia associated with spasm of accommodation in children and adults is a rare clinical condition. When occurring with pupillary miosis and restricted ocular motility, it is referred to as "spasm of near reflex" (SNR) and may require neurological investigation. The natural history of SNR depends on its etiology. There is little information in the literature regarding the long-term follow-up of SNR and the stability of visual signs and symptoms following cessation of treatment. We report a case of SNR in an otherwise healthy young male, and discuss the presentation, clinical investigations, management, response to treatment, and 1-year follow-up.
  
  
  METHODS
  A 23-year-old male patient reported to the clinic with sudden onset of blurred vision, inward deviation of the eyes, and binocular diplopia. On examination, he was diagnosed to have acute onset esotropia resulting from SNR. He was treated with cycloplegic medications and vision therapy. The condition resolved following 1 year and there has been no recurrence.
  
  
  CONCLUSIONS
  Acute adult onset esotropia occurring with accommodative spasm responds favorably to cycloplegic medications but may need a longer course of treatment for successful resolution and stability.
authors.affiliation: *MPhil, FCOVD-I, FAAO †MPhil ‡MS, DNB §PhD ∥MS, MPhil Srimathi Sundari Subramanian Department of Visual Psychophysics (JRH, RM, KKR), Elite School of Optometry, Unit of Medical Research Foundation, Chennai, and Pediatric Ophthalmology Department (JRH, RM, SA, STS), Sankara Nethralaya, Chennai, India.
authors.forename: Jameel Rizwana
authors.initials: JR
authors.lastname: Hussaindeen
authors.forename: Revathy
authors.initials: R
authors.lastname: Mani
authors.forename: Sumita
authors.initials: S
authors.lastname: Agarkar
authors.forename: Krishna Kumar
authors.initials: KK
authors.lastname: Ramani
authors.forename: Thandalam Sundararajan
authors.initials: TS
authors.lastname: Surendran
mesh_terms: D000065:Accommodation, Ocular; D000208:Acute Disease; D001285:Atropine / Q000627:therapeutic use; D004948:Esotropia / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*; D006801:Humans; D008297:Male; D009184:Mydriatics / Q000627:therapeutic use; D015835:Ocular Motility Disorders / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D012029:Refraction, Ocular / Q000502:physiology; D014792:Visual Acuity / Q000502:physiology; D055815:Young Adult
chemical_list: D009184:Mydriatics; D001285:Atropine