Loss of binocular vision (diplopia) and acute comitant esotropia following surgical patch removal after unilateral penetrating keratoplasty for keratoconus; management.

PURPOSE: To report a case of acute comitant esotropia after monocular penetrating keratoplasty (PKP).

CASE REPORT: We present a 17 year old male patient with bilateral keratoconus who underwent penetrating keratoplasty in his right eye. He experienced diplopia after removal of the patch from the operated eye due to a new comitant esotropia in his left (unoperated) eye. Diplopia was controlled using prism glasses and then botulinum toxin injections until a penetrating keratoplasty was performed in his left eye and binocular vision and fusion returned.

CONCLUSION

Acute comitant esotropia may occur after loss of binocular vision and fusion due to brief ocular patching in a vulnerable patient. Fusion can be preserved with non-surgical methods until it can be permanently restored.