MANAGEMENT OF AACE (ACUTE ACQUIRED COMITANT ESOTROPIA) BY BOTULINUM TOXIN-A INJECTION

Abstract

Background: Treatment options for AACE (acute acquired comitant esotropia) include strabismus surgery, botulinum 
toxin injection, and/or prism use, either alone or in combination. To restore binocularity, alleviate diplopia, and correct 
eye alignment, botulinum toxin is injected into the medial rectus muscle.  
Aim: The purpose of this study was to evaluate the effects of injecting patients with AACE (acute acquired comitant 
esotropia) with botulinum toxin A. 
Methods: The predetermined study evaluated 54 individuals who visited the Institute throughout the specified study 
period and had a confirmed diagnosis of botulinum toxin A injection in persons with AACE acute acquired comitant 
esotropia. Participants in the research received botox injections and were monitored for at least three months. Every 
participant received a thorough neuroimaging, orthoptic evaluation, and ophthalmic examination. 
Results: The study included 14 females and 40 males, with a mean age of 10 years. Near pre-injection and distance had 
median deviations of 40 and 35 prism diopters, respectively. 66.6% (n=36) of the participants showed full symptom 
remission. Eight subjects required prisms, four required recurrent injections, and two required both divergence therapy 
and surgery. Twelve participants acquired ptosis, and no risk factor was shown to have an impact on the results.  
Conclusion: The current study suggests that injecting botulinum toxin into the medical rectus muscle is a safe and 
effective way to treat patients with acute acquired comitant esotropia, or AACE. In such cases, pre-injection counseling 
regarding ptosis, surgery, reinjection, and recurrence requiring prism is essential.