Acute Comitant Esotropia Following Penetrating Keratoplasty

PURPOSE: To report a case of acute comitant esotropia in a patient with bilateral keratoconus presenting after penetrating keratoplasty (PKP) in the fellow eye. CASE REPORT: A 17-year-old male patient with bilateral keratoconus underwent PKP in his right eye. He experienced diplopia after removal of the patch from the operated eye 12 hour postoperatively due to esotropia in his left (unoperated) eye. Diplopia was controlled using prism glasses and botulinum toxin A injections until PKP was performed in his left eye which resulted in restoration of stable fusion up to 3 years of follow up. CONCLUSION: Acute comitant esotropia may occur after loss of fusion due to ocular patching in a vulnerable patient. In this patient fusion was preserved with non-surgical methods until it was restored by surgical means.