Divergence Insufficiency Esotropia Associated with Excessive Near Work During the Coronavirus Pandemic

PURPOSE: The COVID-19 lockdown has had a profound impact on people's lifestyles - especially the youth - through school closures and home confinement. Accordingly, the excessive use of smartphones and digital devices made adolescents vulnerable to the adverse effects of excessive near work on the eyes. METHOD: Four adolescents (10-17 years) with acute acquired divergence insufficiency esotropia were evaluated. RESULTS: The mean age of our patients was 14 years old (10-17). Their mean deviation at distance was 32.5 PD (25-40 PD), and their mean near deviation was 13 PD (8-20 PD). All patients had normal neurological examinations and exhibited normal brain and orbital MRI results. Excessive near work with digital devices such as smartphones after the COVID-19 lockdown was the only risk factor identified. All cases were successfully treated with bilateral lateral rectus resection. A 3.5- to 5.5-mm bilateral lateral rectus resection corrected 25 to 40 PD esotropia at distance without overcorrection at near. CONCLUSION: Decreased outdoor activities and excessive near work during the COVID-19 pandemic could be associated with divergence insufficiency esotropia in adolescents. Bilateral lateral rectus resection is an acceptable surgical treatment.