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The incidence, clinical features, and management of essential infantile esotropia in the United Kingdom. A British Ophthalmology Surveillance Unit (BOSU) study

Eye volume 38, pages 680–686 (2024)Cite this article

Subjects

Learning objectives

Upon completion of this activity, participants will be able to:

  1. 1.

    Distinguish the annual incidence of essential infantile esotropia (EIE) in the current study.

  2. 2.

    Assess the mean ages at diagnosis and intervention for EIE in the current study.

  3. 3.

    Compare characteristics of children who received observational management for EIE vs active interventions.

  4. 4.

    Evaluate outcomes of surgical treatment for EIE vs botulinum toxin in the current study.

Accreditation statements

In support of improving patient care, this activity has been planned and implemented by Medscape, LLC and Springer Nature. Medscape, LLC is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.

Medscape, LLC designates this Journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Credit hours

1.0

Release date: February 2, 2024

Expiration date: February 2, 2025

Post-test link: https://www.medscape.org/eye/posttest999130

EDITOR

Sobha Sivaprasad, MD, Editor, Eye

Journal CME author disclosure information

Charles P. Vega has the following relevant financial relationships: Consultant or advisor for Boehringer Ingelheim Pharmaceuticals, Inc.; GlaxoSmithKline; Johnson & Johnson Services, Inc.

Abstract

Background/objectives

A national study was undertaken through the British ophthalmology surveillance unit (BOSU) to determine the incidence, presenting features and management of essential infantile esotropia (EIE) in the UK.

Methods

Data from a prospective national observational study of newly diagnosed EIE presenting to clinicians in the United Kingdom over a 12-month period were collected. Cases with a confirmed diagnosis by a clinician of a constant, non-accommodative esotropia ≥20 prism dioptres (PD), presenting at ≤12 months, with no neurological or ocular abnormalities were identified through BOSU. Follow-up data were collected at 12 months.

Results

A total of 57 cases were reported giving an incidence of EIE of 1 in 12,828 live births. The mean age of diagnosis and intervention were 7.05 ± 2.6 months (range 2–12) and 14.7 ± 4.9 months (range 6.5–28.1), respectively. Management was surgical in 59.6%, botulinum toxin alone in 22.8%, and 17.5% were observed. The preoperative angle of esotropia was smaller in the observation group (P = 0.04). The postoperative angle of esotropia was not statistically significant between botulinum toxin or surgery (P = 0.3), although the age of intervention was earlier in the botulinum group (P = 0.007). Early intervention (before 12 months of age) did not influence the post-intervention motor outcomes between 0 and 10 prism dioptres of esotropia (P = 0.78).

Conclusions

The incidence of EIE in the UK is considerably lower than reported in other population-based studies. The preferred method of treatment was surgical with earlier intervention in those treated with botulinum toxin. An early age of intervention (<12 months) did not influence motor outcomes.

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Fig. 1: Box plots of pre-intervention angle.
Fig. 2: Age of intervention.

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Data availability

The datasets generated during and/or analysed during the current study are available from the corresponding author on reasonable request. This data will not be available past 2030.

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Acknowledgements

Special thanks to Anwen Coughlan and Tina McDonald for their help with the data collection. Special thanks to the following for their participation in the BOSU study: Adam Bates, Anna Maino, Annegret Dahlmann-Noor, Anthony Quinn, Clare Roberts, Conrad Schmoll, Geeta Thurairajan, Gill Adams, I.Chris Lloyd, Jan Hoole, Jane Ashworth, Jeremy Butcher, Joanne Hancox, John Ferris, Kate Taylor, Lawrence Gnanaraj, Louise Allen, Lucy Barker, Luke Clifford, M.Ashwin Reddy, Manor Parulekar, Maria Theodorou, Maria Tsimpida, Peter Tiffin, Richard Bowman, Richard Smith, Robert Taylor, Rod Savides, Rosemary Lambley, Rosie Brennan, Stephanie West, Tamsin Sleep, Tina Duke, Vasileios Kostakis, Vernon Geh, Alan Mulvihill, Annie Joseph, Anthony Vivian, Aravind Reddy, Bina Parmar, Dinesh Dave, David Jones, G. A. Shun-Shin, James Acheson, Kate Bush, Michael Clarke, Shona Sutherland, Stephen Burgess, Susmito Biswas, Tina Duke, and Victoria Barrett.

Funding

The Paediatric Eye Fund at Cardiff and Vale University Health Board kindly funded a total of £5000.

Author information

Authors and Affiliations

  1. Alder Hey Children’s NHS Foundation Trust, Liverpool, UK

    Damien C. M. Yeo

  2. Aneurin Bevan University Health Board, Newport, UK

    Ryan Davies

  3. College of Biomedical & Life Sciences, Cardiff University, Cardiff, UK

    W. John Watkins

  4. University Hospital of Wales, Cardiff, UK

    Patrick Watts

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Contributions

DCMY: research design, data collection, data analysis, manuscript preparation. RD: data collection. WJW: data analysis. PW: research concept, research design, data analysis, manuscript preparation.

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Correspondence to Patrick Watts.

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Yeo, D.C.M., Davies, R., Watkins, W.J. et al. The incidence, clinical features, and management of essential infantile esotropia in the United Kingdom. A British Ophthalmology Surveillance Unit (BOSU) study. Eye 38, 680–686 (2024). https://doi.org/10.1038/s41433-023-02901-5

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