Divergence Insufficiency Esotropia Associated With Excessive Near Work During the Coronavirus Pandemic Publisher Pubmed



Tavakolizadeh S ; Akbari MR ; Khabazkhoob M ; Mehrpour M
Source: Journal of Binocular Vision and Ocular Motility Published:2026

Abstract

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. © 2026 American Orthoptic Journal Inc.