Purpose <p>To report the changes in the Acute Acquired Comitant Esotropia (AACE) cases before and after the COVID-19 era.</p> Methods <p>Records of all AACE patients from 2016 to 2023 were gathered in this cross-sectional study. Patients were categorized by age into two groups: Group A (≤12 years) and Group B ( &gt; 12 years), and their demographic characteristics were compared. The “AACE/esotropia” ratio and the “AACE/total strabismus” ratio were calculated by dividing the total number of AACE cases by total esotropia operations and total strabismus operations.</p> Results <p>A total number of 160 AACE cases, including 118 male individuals, were identified. Over 89% of our participants fell into Group A. Hyperopia was more common among Group A cases, whereas myopia was more frequently seen in Group B (<i>p</i> &lt; 0.001). Esotropia was larger, and diplopia was less frequently recorded in Group A compared to Group B (<i>p</i> &lt; 0.001). We observed a slow-increasing pattern in the total number of AACE and the AACE ratios from 2016 to 2019, which sharply increased in 2020 with the beginning of the COVID-19 era. Interestingly, the total number of AACE cases and the AACE ratios decreased after emerging from the COVID-19 lockdown years.</p> Conclusions <p>Despite the worldwide increasing trend of AACE cases, our total number of cases spiked noticeably in 2020, followed by a decrease thereafter in 2022 and 2023. This suggests a potential link between lifestyle changes during lockdown years, physical and psychosocial stress induced by COVID-19, and the occurrence of AACE.</p>