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Klinika Oczna / Acta Ophthalmologica Polonica
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vol. 126
Letter to the Editor

Acute acquired comitant esotropia in the era of the COVID-19 pandemic

Ali Nouraeinejad

  1. Department of Clinical Ophthalmology, University College London (UCL), London, United Kingdom
KLINIKA OCZNA 2024, 126, 1: 48
Online publish date: 2024/03/27
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Acute acquired comitant esotropia (AACE) is an uncommon subtype of esotropia characterized by sudden late onset of comitant esotropia with diplopia in older children and adults [1-3]. Pathological and non-pathological causes have been documented for AACE [1, 3]. AACE infrequently occurs. However, the prevalence of AACE has been reported to be increasing in the era of the coronavirus disease 2019 (COVID-19) pandemic due to the excessive near work use of mobile phones/smartphones, and other digital screens to apply electronic learning for school or university educational lessons during home confinement [4, 5]. In this regard, the association between electronic learning and myopia progression among school-age children during the COVID-19 pandemic has also already been reported by the author [6].
In addition, these findings are in agreement with the earlier reports of increases in the prevalence of AACE, which were also associated with the excessive near work use of mobile phones/smartphones, and other digital screens [2, 7].
The author has also noticed an increased number of patients with AACE in his practice in recent years due to the concurrent excessive near work activities, especially on smartphones [3, 8]. These observations conjointly indicate that persistent near work, especially on smartphones, can cause AACE, and the author proposes this hypothesis, which can be further examined by researchers in this area. This author’s hypothesis is partly supported by those documents that noted a decrease in the degree of esodeviation after refraining from mobile phone/smartphone use [2, 4, 5]. In the meantime, the author recommends that public health workers and policymakers should be vigilant on this issue and implement preventive measures to care for people’s visual health.


The author would like to express his gratitude and high respect for the lifetime support of his father, Mohammad Nouraeinejad.


The author declares no conflict of interest.

Corresponding author

Ali Nouraeinejad, PhD, Department of Clinical Ophthalmology, University College London (UCL), London, United Kingdom, e-mail:


1. Nouraeinejad A. Binocular Vision Anomalies. Moorfields Eye Hospital, London 2016.
2. Lee HS, Park SW, Heo H. Acute acquired comitant esotropia related to excessive Smartphone use. BMC Ophthalmol 2016; 16: 37.
3. Nouraeinejad A. Differential Diagnosis in Optometry and Ophthalmology. Second Edition. Noruzi Publication, Iran 2017.
4. Vagge A, Giannaccare G, Scarinci F, et al. Acute Acquired Concomitant Esotropia From Excessive Application of Near Vision During the COVID-19 Lockdown. J Pediatr Ophthalmol Strabismus 2020; 57: e88-e91. [Erratum in: J Pediatr Ophthalmol Strabismus 2020; 57: 408].
5. Neena R, Remya S, Anantharaman G. Acute acquired comitant esotropia precipitated by excessive near work during the COVID-19-induced home confinement. Indian J Ophthalmol 2022; 70: 1359-1364.
6. Nouraeinejad A. The Association Between Electronic Learning and Myopia Progression Among School-Age Children During the Coronavirus Disease 2019. Beyoglu Eye J 2022; 7: 154-155.
7. Song J, Kim SK, Choi MY. Clinical Characteristics and Outcomes of Smartphone Overusers with Acute Acquired Comitant Esotropia. J Korean Ophthalmol Soc 2018; 59: 169-175.
8. Nouraeinejad A. Visual Hygiene. Moorfields Eye Hospital, London 2019.
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