Accommodative esotropia associated with low-dose atropine for myopia control: a case report with longitudinal AC/A ratio.

Low-dose atropine (LDA) is effective for slowing myopia progression and preventing its onset in children. It is generally considered safe. The main adverse effects are mild photophobia and blurred vision at near secondary to accommodative dysfunction. Esotropia is a rare adverse event that can occur in temporal association with LDA. We report a pediatric case of near-esotropia that emerged after the initiation of 0.025% low-dose atropine for myopia control and onset prevention and resolved after discontinuation; the longitudinal accommodative convergence-to-accommodation (AC/A) ratio assessments documented a transient elevation during treatment, with subsequent normalization off-therapy. To our knowledge, this is the first report documenting longitudinal AC/A ratio changes during and after low-dose atropine therapy.