To report the results of a series of patients with acquired distance esotropia (ET) who underwent lateral rectus resection.

We retrospectively analysed data from 21 symptomatic patients with acquired esotropia who did not tolerate prisms. Twelve patients had myopic esotropia, 5 patients decompensated esophoria and 4 patients age-related distance esotropia. Patients were divided in two groups; myopic and non myopic. Two patients in each group had undergone surgery to medial recti muscles previously. Near and distance angles were measured over 2 visits. Data were analysed with t-test (paired and unpaired).

Average age was 47 (myopes), 77 (distance ET) and 26 years (esophoria). Mean spherical equivalent was -4.00 DS (myopes) and + 1 SD (non myopes). Lateral rectus resection ranged between 6 and 8 mm with an average of 7 mm in the myopic group and between 4 and 8 mm with an average of 6 mm in the non-myopic group.

The distance angle was reduced from 19 PD to 6 PD in myopes (mean difference 12 PD, p<0.0001) and from 19 PD to 8 PD in non myopes (mean difference 12 PD, p=0.0011). There was no difference in reduction of distance angle between myopes and non-myopes (p=0.771). All patients had complete resolution of diplopia after surgery without needing prisms. Near angle was also fully corrected in 19 patients. One patient with myopia and one patient with distance esotropia went on to have medial rectus recession.

Unilateral lateral rectus resection is an effective procedure for acquired distance esotropia in myopic and non-myopic patients.