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JAMA Ophthalmology Clinical Challenge
April 15, 2021

Intermittent Esotropia in an Adult

Author Affiliations
  • 1Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota
  • 2Department of Neurology, Mayo Clinic, Rochester, Minnesota
JAMA Ophthalmol. 2021;139(6):674-675. doi:10.1001/jamaophthalmol.2020.4929

A 33-year-old woman was referred for evaluation of intermittent esotropia. When playing video games at a distance or when reading, she developed oscillopsia with eyestrain and noted that her right eye turned up and in. She had undergone strabismus surgery for crossed eyes as a young child and more recently had laser in situ keratomileusis performed. She was medically healthy and neurodevelopmentally normal but had been born 4½ weeks premature. There was no family history of strabismus, and she denied diplopia.

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    1 Comment for this article
    Role of laser in situ keratomileusis
    Alfred Cossari, MD | Northwell Health
    It certainly appears that this patient's recent refractive surgery played an important role in disturbing a previously well-controlled residual monofixational esotropia with DVD, DHD and latent nystagmus. If refractive surgery was performed to treat myopia, did she previously wear contact lenses with a monovision correction or, perhaps, mostly wear glasses and remove them for reading? Such myopia-related accommodative insufficiency might easily produce a decompensation of her esotropia beginning at near fixation after successful refractive surgery. If neither of these situations are relevant, what other factors related to her refractive surgery might provide an added lesson from this well managed and most interesting presentation?