Characteristics and surgical results in patients with age-related divergence insufficiency esotropia

Purpose To describe the clinical characteristics and surgical outcomes of a group of patients at least 40 years of age with adult-onset divergence insufficiency esotropia. Methods The medical records of consecutive adult patients diagnosed with divergence insufficiency between 1977 and 2011 were retrospectively reviewed. Clinical features evaluated included age at diagnosis, visual acuity, primary position deviations at distance and near, treatment offered, postsurgical deviations, and presence of neurological diagnosis based on medical history. Results A total of 85 patients (52 females [61%]) were identified. The mean age at diagnosis was 74 years. The mean visual acuity in the better-seeing eye was 20/23; in the worse-seeing eye, 20/27. The mean initial esodeviation was 12^Δ at distance and 5.4 ^Δ at near. Seven patients (8%) had been diagnosed with neurological disease and 5 with bilateral abducens nerve pareses without limitation of abduction. Therapeutic prism was used by 60 patients (69%). Bilateral medial rectus muscle recessio (mean, 4.3 mm per muscle) was performed on 37 patients. The average postoperative deviations were 0.6^Δ of esodeviation at distance and 3^Δ of exodeviation at near. Conclusions Few patients with age-related distance esotropia have accompanying neurological disease. Bilateral medial rectus muscle recessions effectively reduced esotropia at distance, with a slight tendency for overcorrection at near.