Prediction tools to prioritise hospitalised adult patients at risk of drug related problems: An umbrella review.

Acute acquired comitant esotropia (AACE) is a rare form of esotropia []. There has been a notable increase in reported cases recently, likely due to the rising use of digital devices, such as smartphones [–]. AACE typically manifests as late-onset esotropia with diplopia in individuals with normal binocular vision [–]. Unlike other forms of esotropia that usually appear in early childhood or are associated with significant hyperopic refractive errors or neurological issues, AACE typically occurs in older children and adults. It is characterized by late-onset esotropia with diplopia, consistent esotropia across all gaze directions, minimal or no significant hyperopia, and the absence of organic diseases such as brain tumors [–]. Neurological examinations and imaging studies, including computed tomography (CT) or magnetic resonance imaging (MRI), generally return normal results, distinguishing AACE from other causes of acute-onset esotropia. Recently, botulinum toxin type A (BTXA) injections have emerged as a less invasive alternative to traditional strabismus surgery [–]. BTXA temporarily paralyzes the overactive medial rectus muscles, thereby facilitating ocular realignment. Studies demonstrate that BTXA can effectively reduce esotropia and improve binocular function with a relatively low risk of complications. In some cases, the effects of BTXA extend beyond the drug’s active period, leading to long-term alignment. Conversely, it remains unclear which specific cases result in long-term success. Moreover, few large-scale studies report these outcomes. This study aimed to investigate the efficacy and safety of BTXA injections in treating AACE while also identifying factors that contribute to successful treatment outcomes.