Acute Acquired Comitant Esotropia in Children Following Excessive Smartphone Use: A Post-COVID-19 (Coronavirus) Lockdown Analysis

Purpose: To evaluate the causes of acute acquired comitant esotropia (AACE) in children and young adults following excessive use of video display terminals (VDT). Methods: We retrospectively analysed 43 patients, aged between 3 and 25 years, with recent-onset esotropia who presented over 24 months at a tertiary eye care hospital. Results: The mean age was 12.14 ± 6.29 years. A majority of 81.4% were male (35/43 patients). The mean duration of smartphone use was 7.22 ± 2.77 h. Cycloplegic refraction showed mild hyperopia in 1 patient, myopia in 5 patients and simple myopic astigmatism in 11 patients. All the remaining patients were emmetropic. About 9 patients (20.9%) complained of diplopia. The average angle of deviation for near and distance was 40.79 ± 13.55 prism diopter (PD) and 38.57 ± 12.21 PD, respectively. Systemic evaluation and magnetic resonance imaging (MRI) of the brain were normal in all children. Appropriate spectacle correction and alternate eye patching were initiated for all. About 26 (60.5%) patients underwent surgical correction. Conclusion: Intensive near work and use of digital devices can precipitate acute esotropia. Clinical Significance: This study underscores the importance of parental awareness and ophthalmologist vigilance regarding screen time-related esotropia in the post-pandemic era.