The COVID-19 pandemic and the abrupt changes in the reported cases of acute acquired comitant esotropia

To report the changes in the Acute Acquired Comitant Esotropia (AACE) cases before and after the COVID-19 era. Records of all AACE patients from 2016 to 2023 were gathered in this cross-sectional study. Patients were categorized by age into two groups: Group A (≤12 years) and Group B ( > 12 years), and their demographic characteristics were compared. The “AACE/esotropia” ratio and the “AACE/total strabismus” ratio were calculated by dividing the total number of AACE cases by total esotropia operations and total strabismus operations. A total number of 160 AACE cases, including 118 male individuals, were identified. Over 89% of our participants fell into Group A. Hyperopia was more common among Group A cases, whereas myopia was more frequently seen in Group B (p < 0.001). Esotropia was larger, and diplopia was less frequently recorded in Group A compared to Group B (p < 0.001). We observed a slow-increasing pattern in the total number of AACE and the AACE ratios from 2016 to 2019, which sharply increased in 2020 with the beginning of the COVID-19 era. Interestingly, the total number of AACE cases and the AACE ratios decreased after emerging from the COVID-19 lockdown years. Despite the worldwide increasing trend of AACE cases, our total number of cases spiked noticeably in 2020, followed by a decrease thereafter in 2022 and 2023. This suggests a potential link between lifestyle changes during lockdown years, physical and psychosocial stress induced by COVID-19, and the occurrence of AACE.