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Clinical practices on acute acquired comitant esotropia: A consensus statement proposed by the Council of Asia-Pacific Strabismus and Pediatric Ophthalmology Society.

Asia Pac J Ophthalmol (Phila)

January 2025

Department of Ophthalmology, Eye Institute, Eye, Ear, Nose and Throat Hospital, Shanghai Medical College, Fudan University, Shanghai, China; Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China; Key laboratory of Myopia and Related Eye Diseases, Chinese Academy of Medical Sciences, Shanghai, China; Key laboratory of Myopia and Related Eye Diseases, NHC, Shanghai, China. Electronic address:

Acute acquired comitant esotropia (AACE) is a concomitant strabismus characterized by sudden onset, mostly associated with diplopia. The prevalence of AACE has significantly increased, and various management approaches have been recommended in recent years. This study by the Council of Asia-Pacific Strabismus and Pediatric Ophthalmology Society aimed to provide an overview of the clinical features, etiology and the nonsurgical and surgical treatment recommendations for the condition to equip strabismus specialists with the most updated knowledge.

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Miller Fisher syndrome (MFS) is a rare Guillain-Barré syndrome (GBS) variant. The global incidence of GBS is approximately one to two in 100,000 children (aged 0 to 15 years) per year. Miller Fisher syndrome represents a further small subset, with the incidence being one to two in 1,000,000 children.

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We report a case of acute ischemic stroke presenting as wall-eyed bilateral internuclear ophthalmoplegia (WEBINO) syndrome. A 71-year-old woman experienced transient diplopia, followed by the sudden onset of binocular misalignment, gait instability, and nausea. Neurological examination demonstrated exotropia and bilateral adduction impairment, consistent with WEBINO syndrome.

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Article Synopsis
  • Spontaneous intracranial hypotension (SIH) is a rare condition often misdiagnosed, particularly in patients with connective tissue disorders like Marfan Syndrome, which can lead to structural weaknesses in the spinal dural membrane and increased risk of CSF leaks.
  • A 52-year-old woman with genetically confirmed Marfan Syndrome presented with severe headaches and diplopia; imaging revealed complications such as dural ectasia and subdural hematoma, which were effectively managed with bed rest and corticosteroids.
  • A review of 25 studies on SIH treatment in patients with Marfan Syndrome indicated high success rates for symptoms improvement, particularly with epidural blood patches and conservative treatments.
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The authors report a case of a 66-year-old man with sudden-onset diplopia and redness in the left eye. The examination revealed left hypotropia with exotropia and limited elevation. Contrast-enhanced computed tomography and histopathology suggested inferior rectus myositis with fibrosis.

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