Low-dose atropine-related esotropia in a myopic child: a case report

Abstract

AIMS/PURPOSE: Acute-onset strabismus in highly myopic children raises a broad differential diagnosis. In this article, we report a pediatric case with high myopia and prolonged near focus who presented concomitant esotropia during treatment with atropine 0.05% eye drops. METHODS: Case report. RESULTS: A four-year-old male presented with progressive myopia, and a habit of prolonged near focus and excessive screen time. He had moderate myopia in both eyes, with no sign of strabismus. Due to the rapid progression of the refractive error over the next visits, low-dose atropine (LDA) drops 0.05% were prescribed. One month later, the patient developed esophoria which soon converted to esotropia. LDA treatment was discontinued with the child's axial length increasing, consistent with continued progression of myopia. Finally, he was switched over to peripheral defocus spectacles. Three years following his initial visit, his tests show stable visual acuity and AL and an esotropia measuring 45 PD. The patient has been scheduled for strabismus surgery. CONCLUSIONS: LDA is an increasingly useful method to control myopia progression; however, any potential side effects should be reported. To our knowledge, this case is one of the first reports of esophoria converting to esotropia in a young patient after atropine was used to control myopic progression.