# Binasal occlusion for the non-invasive management of acute acquired comitant esotropia

## TL;DR

This study shows that binasal occlusion can help reduce eye misalignment in patients with acute acquired comitant esotropia, offering a non-invasive treatment option.

## Contribution

The study provides preliminary evidence that binasal occlusion is effective in managing acute acquired comitant esotropia.

## Key findings

- Binasal occlusion significantly reduced ocular deviation angles in patients with acute acquired comitant esotropia.
- Diplopia resolved in 50% of patients, and fusion function improved significantly after treatment.
- Smaller initial deviations and shorter disease duration were associated with better outcomes, though not independently significant.

## Abstract

To assess the clinical effectiveness of binasal occlusion (BNO) as a non-invasive treatment for acute acquired comitant esotropia (AACE) and to explore potential predictors of therapeutic response.

This retrospective case series included 32 AACE patients who underwent BNO therapy for at least 6 months. Changes in ocular deviation angles, diplopia resolution, and binocular function were assessed before and after treatment. Patients were categorized into cured (orthophoria), effective [≥10 prism diopter (PD) reduction], and ineffective groups. Univariate and multivariate analyses were conducted to identify predictors of therapeutic success.

BNO significantly reduced ocular deviation. The median near deviation decreased from 25.00 PD (IQR 20.00–30.00) to 17.50 PD (IQR 5.50–33.75) (P = 0.002), and the median distance deviation decreased from 30.00 PD (IQR 21.25–40.00) to 20.00 PD (IQR 5.25–35.00) (P < 0.001). Diplopia resolved in 50% of patients (P < 0.001), and fusion function improved significantly (P = 0.019). Smaller initial deviations and shorter disease duration were associated with favorable outcomes in univariate analysis but did not emerge as independent predictors in multivariate analysis, suggesting a potential synergistic interaction.

BNO represents a promising, non-invasive intervention for AACE, particularly in cases with smaller deviations and early presentation. This case series provides preliminary evidence that BNO may reduce deviation and potentially lower surgical need. However, the absence of a control group precludes causal inference. Future randomized controlled trials with standardized outcomes are needed to confirm efficacy and define BNO's role in AACE management.