Clinical Characteristics and Analysis of Spontaneous Consecutive Exotropia in Children with Refractive Accommodative Esotropia.

Objectives: To assess the clinical characteristics and risk factors associated with spontaneous consecutive exotropia (ScXT) in children diagnosed with refractive accommodative esotropia (RAET). Materials and Methods: A retrospective analysis of medical records was conducted on 19 patients who demonstrated a spontaneous transition from RAET to exotropia (XT). Patients who received strabismus surgery or botulinum toxin injection were excluded from the study. The control group consisted of 31 age-matched patients with RAET who demonstrated successful optical alignment at both near and distance. The ophthalmological examination findings of the study and control groups were compared. Independent two-sample t-test and Pearson's chi-square test were used to evaluate the data of the patients. Results: The study examined patients diagnosed with RAET who developed consecutive XT. Among them, 15 (78.9%) were female and 4 (21.1%) were male. The mean age at esotropia (ET) onset was 22.68 months (standard deviation [SD]: 12.91). The control group consisted of 16 (51.6%) female and 15 (48.4%) male patients, with a mean age at ET onset of 25.09 months (SD: 15.47). Mean age at onset did not differ between the groups (p=0.55). The mean interval between ET onset and appearance of XT was 7.53 years (SD: 1.49). Cycloplegic refraction measurements taken during the initial examination indicated that the study group exhibited greater degrees of hypermetropia in their right (p=0.01) and left (p=0.04) eyes than did the control group. Furthermore, the incidence of inferior oblique muscle overaction was higher among the study group (p=0.03). Conclusion: The findings indicate that patients with high hypermetropic refraction values should be monitored for an extended period due to the increased risk of developing subsequent XT. Concomitant inferior oblique overaction can increase the risk of ScXT.