{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,9]],"date-time":"2026-03-09T06:19:50Z","timestamp":1773037190776,"version":"3.50.1"},"reference-count":26,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,3,9]],"date-time":"2026-03-09T00:00:00Z","timestamp":1773014400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>To assess the clinical effectiveness of binasal occlusion (BNO) as a non-invasive treatment for acute acquired comitant esotropia (AACE) and to explore potential predictors of therapeutic response.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This retrospective case series included 32 AACE patients who underwent BNO therapy for at least 6 months. Changes in ocular deviation angles, diplopia resolution, and binocular function were assessed before and after treatment. Patients were categorized into cured (orthophoria), effective [\u226510 prism diopter (PD) reduction], and ineffective groups. Univariate and multivariate analyses were conducted to identify predictors of therapeutic success.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      BNO significantly reduced ocular deviation. The median near deviation decreased from 25.00 PD (IQR 20.00\u201330.00) to 17.50 PD (IQR 5.50\u201333.75) (\n                      <jats:italic>P<\/jats:italic>\n                      = 0.002), and the median distance deviation decreased from 30.00 PD (IQR 21.25\u201340.00) to 20.00 PD (IQR 5.25\u201335.00) (\n                      <jats:italic>P<\/jats:italic>\n                      &amp;lt; 0.001). Diplopia resolved in 50% of patients (\n                      <jats:italic>P<\/jats:italic>\n                      &amp;lt; 0.001), and fusion function improved significantly (\n                      <jats:italic>P<\/jats:italic>\n                      = 0.019). Smaller initial deviations and shorter disease duration were associated with favorable outcomes in univariate analysis but did not emerge as independent predictors in multivariate analysis, suggesting a potential synergistic interaction.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>BNO represents a promising, non-invasive intervention for AACE, particularly in cases with smaller deviations and early presentation. This case series provides preliminary evidence that BNO may reduce deviation and potentially lower surgical need. However, the absence of a control group precludes causal inference. Future randomized controlled trials with standardized outcomes are needed to confirm efficacy and define BNO's role in AACE management.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fmed.2026.1742695","type":"journal-article","created":{"date-parts":[[2026,3,9]],"date-time":"2026-03-09T05:29:15Z","timestamp":1773034155000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Binasal occlusion for the non-invasive management of acute acquired comitant esotropia"],"prefix":"10.3389","volume":"13","author":[{"given":"Ruiying","family":"Li","sequence":"first","affiliation":[{"name":"Department of Ophthalmology, Peking University First Hospital","place":["Beijing, China"]},{"name":"Peking University Pediatric Vision Research Center","place":["Beijing, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ruoshi","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, Peking University First Hospital","place":["Beijing, China"]},{"name":"Peking University Pediatric Vision Research Center","place":["Beijing, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xiaoqing","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, Peking University First Hospital","place":["Beijing, China"]},{"name":"Peking University Pediatric Vision Research Center","place":["Beijing, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2026,3,9]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"87","DOI":"10.22336\/rjo.2023.16","article-title":"Management of acute acquired comitant esotropia in children","volume":"67","author":"Dragomir","year":"2023","journal-title":"Rom J Ophthalmol."},{"key":"B2","doi-asserted-by":"publisher","first-page":"95","DOI":"10.1016\/j.ajo.2018.07.007","article-title":"Decompensated esophoria as a benign cause of acquired esotropia","volume":"194","author":"Hassaan Ali","year":"2018","journal-title":"Am J Ophthalmol."},{"key":"B3","doi-asserted-by":"publisher","first-page":"636","DOI":"10.1136\/bjo.73.8.636","article-title":"Acute acquired comitant esotropia","volume":"73","author":"Clark","year":"1989","journal-title":"Br J Ophthalmol."},{"key":"B4","doi-asserted-by":"publisher","first-page":"3382","DOI":"10.4103\/ijo.IJO_318_22","article-title":"Independent risk factors of type III acute acquired concomitant esotropia: a matched case-control study","volume":"70","author":"Zhang","year":"2022","journal-title":"Indian J Ophthalmol."},{"key":"B5","doi-asserted-by":"publisher","first-page":"1359","DOI":"10.4103\/ijo.IJO_2813_21","article-title":"Acute acquired comitant esotropia precipitated by excessive near work during the COVID-19-induced home confinement","volume":"70","author":"Neena","year":"2022","journal-title":"Indian J Ophthalmol."},{"key":"B6","doi-asserted-by":"publisher","first-page":"1567","DOI":"10.2147\/OPTH.S307951","article-title":"Acute acquired comitant esotropia: etiology, clinical course, and management","volume":"15","author":"Lekskul","year":"2021","journal-title":"Clin Ophthalmol."},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.3390\/children11050519","article-title":"Still an unsolved question: the place of cranial magnetic resonance imaging in acute acquired concomitant esotropia","author":"Mittendorf","year":"2024","journal-title":"Children."},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.3389\/fmed.2023.1219419","article-title":"The efficacy of botulinum toxin type A treatment and surgery for acute acquired comitant esotropia","author":"Li","year":"2023","journal-title":"Front Med."},{"key":"B9","doi-asserted-by":"publisher","first-page":"33","DOI":"10.1016\/j.ajo.2016.12.024","article-title":"Comparison of botulinum toxin with surgery for the treatment of acute-onset comitant esotropia in children","volume":"176","author":"Wan","year":"2017","journal-title":"Am J Ophthalmol."},{"key":"B10","doi-asserted-by":"publisher","first-page":"558","DOI":"10.1016\/j.oftale.2022.06.009","article-title":"Lia\u00f1o P. 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