Acute-onset esotropia and diplopia associated with transient hyperopic shift in a child with newly diagnosed diabetes.

We report a rare presentation of acute-onset diplopia and esotropia in a child as a manifestation of transient diabetes-related refractive change. A 9-year-old girl presented with sudden diplopia and large-angle esotropia shortly after initiation of insulin therapy for newly diagnosed type 1 diabetes mellitus. Cycloplegic refraction revealed a marked bilateral hyperopic shift, significantly exceeding her previously documented refractive error. Ocular alignment demonstrated a substantial accommodative component to her esotropia, with good visual acuity in both eyes and no neurologic signs. Over several weeks, as metabolic control stabilized, the hyperopia gradually regressed toward baseline, accompanied by spontaneous improvement in ocular alignment and resolution of diplopia. This case highlights an uncommon pediatric presentation of diabetes-related refractive change manifesting primarily as acute strabismus. Awareness of this phenomenon may help avoid unnecessary neurologic investigations and premature intervention in selected clinical scenarios.