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Smartphone Excess and Acquired Esotropia

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Special thanks to our referring pediatric ophthalmologist, Dr. Tom Lenart, for sharing this interesting and important article with THE VISIONHELP BLOG. Dr. Lenart specialized in treating many eye issues, specifically lazy, crossed or wandering eyes. We have the privilege to share care of select patients with Dr. Lenart making sure they receive the best possible care! Below, Dr. Lenart and THE VISIONHELP BLOG describe how extended phone use can trigger Esotropia.

Acute Acquired Comitant Esotropia Related to Excessive Smartphone Use

An iconic optometrist, A.M. Skeffington, noted that the origin of many binocular visual problems is rooted in socially compulsive, biologically unacceptable, sustained nearpoint tasks – for which the Smartphone is a poster child. Visual stress and a shift in the inward or eso binocular direction has long been associated with sustained nearpoint activities, and Smartphone compounds this because of the font size, usage pattern, and close working distance (often well inside the Harmon distance).

This article is unique in presenting a case series, and all 12 children involved had esotropia develop during the time period when they became Smartphone addicted. All had imaging studies and other tests to rule out underlying disease origins, and 7 of the 12 had sufficient reduction in the inward turn by de-toxing from Smartphone use so that surgery could be avoided. It is noteworthy that none of the patients had lens, prism, or optometric vision therapy applications, but given the functional nature and time frame of the acquired strabismus this could only be of further benefit. The number of patients is small, and the follow-up period isn’t long, but it is a welcome addition to the literature indicating the need for moderation in Smartphone use and vigilance by parents and practitioners regarding signs and symptoms of sustained nearpoint stress and appropriate interventions.


Written by Dr. David Kading

Dr. Kading is active in various dry eye, contact lens, and contact lens solution research studies, and is a consultant and key opinion leader for several eye care manufacturers. He writes articles and has performed hundreds of lectures nationally and internationally on the topics of keratoconus, irregular corneas, dry eye, anterior segment disease, contact lenses, contact lens solutions, and practice management.

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