LAUSR

decompensated monofixation syndrome (type IV);one (1.9%)hadaccommodative convergence excess without far-distance deviation; three (5.7%) had intracranial diseases (ICD; typeV).Nocyclic (typeVI) or secondary (type VII) AACE was found. In accordance with previous studies (Cho et al. 2009; Buch&Vinding 2015), the most common type was accommodative AACE (type III): nine children [32.1%, mean age 3.6 1.1 years (2–5)] had pure refractive accommodative AACE, ten [35.7%, 2.4 0.1 years (1–4)] had partially refractive accommodative AACE, and nine [32.1%, 3.6 1.8 years (1–6)] had accommodative decompensated monofixation syndrome. The deviation was significantly greater for near distance [nd, mean 41.6 prism dioptres (pd) 16.6 (10–70)] than for fd [mean 31.4 pd 16.4 (4– 60), p = 0.02]. The second most common type was idiopathic AACE (type II). Fourteen children (70%) showed an early onset [mean 2.4 0.6 years (1–3)] and six (30%) a late onset [mean 4.5 0.8 years (4–6)]. The deviation was greater for nd [mean 42.6 pd 10.6 (20–64)] than for fd [mean 37.2 pd 9.2 (24–40)], with nd > fd in 13 (65%) and nd = fd in 7 (35%) cases. The degree of hyperopia was less than for children with accommodativeAACE (1.68 1.2 dioptres in spherical equivalent [D(se), 0–3.5) versus 2.75 1.4 D (se, 1–5.5), p = 0.01]. Precipitating stressors were reported in four cases (13.8%), including three febrile infections and psychological stress at the hairdresser. Three cases (5.7%) were associated with ICD (type V). The first was a 3year-old boy with a sinus vein thrombosis. He presented with nystagmus, bilateral papilloedema, a deviation nd > fd [40 pd and 30 pd, hyperopia of 1 D(se)] and absent family history. Case two was a 2-year-old boy with congenital mega cisterna magna and s/ p hydrocephalus, 3.5 D(se) hyperopia, positive family history and a deviation of 40 pd (fd = nd). Case three was a 2year-old girl with viral meningitis and 5.5 D(se) hyperopia causing accommodative strabismus when the infection started [negative family history, deviation of 30 pd (nd) and 40 pd (fd)]. In conclusion, our findings affirm the value of most risk factors (RFs) for ICD described by Buch & Vinding (2015) and confirm accommodative strabismus to be the typical cause of AACE. The diagnosis of AACE led to the detection of an ICD in one of our cases. This child would have been identified by the screening fromBuch et Vinding, showing the RFs nystagmus and papilloedema. Two further children were referred from a children’s hospital with already known ICDs, other neurological pathologies and AACE. Similar to Buch & Vinding (2015); low hyperopia was not a significant RF, and also no children were myopic. A majority of our children [32 of 50 (64%)] without ICDs had hyperopia <3 D(se). From our point of view, accommodative AACE can be diagnosed without magnetic resonance imaging (MRI) in most cases. Therefore, the crucial point of interest is to separate idiopathic from neurological AACE. Our data and other literature (Sturm et al. 2012) reveal a small degree of hyperopia in idiopathic AACE. Hence, we would recommend that the value of hyperopia as a RF should not be overestimated. The limitation of our study is the small number of ICDs. Because neurological AACE (type V) is so rare, more data concerning this issue are needed. We consider the elaboration of RFs to be important for deciding how invasive diagnostic testing should be.