Abstract

Case: A 19 year old girl presented for the first time at 3.5 years with subacute onset inward deviation of left eye.She had orthotropia for distance and 10∆esotropia for near.She was given full cycloplegic +4.50 correction.As she grew up,near esotropia gradually built upto 30∆.She had AC/A ratio of 6:1 and was given executive bifocals with +3 add.At 10 years,withdrwal of bifocals was completed successfully.However at 16 years,with exam stress, online classes she had double vision for near and had to return to bifocals.She had varying angles with myopic non-cycloplegic refraction changing to hypermetropic reflex on cycloplegia.She was started on topical atropine,antianxiety medications along with bifocals. The symptoms of spasm resolved and atropine was gradually tapered.However she again had diplopia at 19 years and received injection Botulinum toxin 2.5 units in left medial rectus without reinitiation of atropine or bifocals.After 2 months she was orthotropic and symptom free.