Acquired Esotropia Associated with Electronic Screen Overexposure: A Neurofunctional Reinterpretation under the INOV Model

Introduction The increasing use of electronic devices has profoundly modified contemporary visual behavior, particularly among adolescents and young adults exposed to prolonged near-vision demands. In recent years, multiple reports have described acute acquired comitant esotropia associated with excessive smartphone and digital screen use. Although most traditional interpretations have focused on accommodative and vergence mechanisms, several clinical findings remain insufficiently explained, including angular variability, incomitance, differential susceptibility among individuals, and the relatively low prevalence of significant hyperopia in many affected patients. Objective To clinically and statistically characterize a multicenter series of patients with acquired esotropia associated with prolonged electronic screen exposure and to reinterpret the observed findings under a neurofunctional model of adaptive visual system stability based on the INOV framework (Neurofunctional Integration and Visual Optimization). Methods A retrospective, observational, multicenter, cross-sectional study was conducted in 53 patients diagnosed with acute acquired comitant esotropia associated with prolonged exposure to electronic devices. Demographic, refractive, motor, and functional variables were analyzed. Statistical analysis included descriptive statistics and nonparametric testing. Results Mean patient age was 20.72 years, with an average daily screen exposure time of 7.83 hours. Most patients exhibited mild refractive errors, with a relative predominance of myopic and astigmatic profiles over significant hyperopia. Angular variability across time and viewing distance, as well as incomitant motor behavior, were identified in a substantial proportion of cases. No statistically significant linear correlation was observed between screen exposure time and deviation magnitude. Favorable clinical responses following botulinum toxin injection and medial rectus surgery suggest the participation of dynamic sensorimotor and proprioceptive mechanisms within binocular regulation. Conclusions Acquired esotropia associated with electronic screen overexposure may represent the clinical expression of a functionally unstable visual system subjected to sustained neurosensory perturbation. Angular variability and incomitance may constitute markers of adaptive neurofunctional reorganization rather than exclusively peripheral mechanical abnormalities. Under the INOV model, botulinum toxin and extraocular muscle surgery may be reinterpreted as directed therapeutic perturbators capable of modulating dynamic visual system states through sensorimotor and proprioceptive reorganization.