Esotropia

ESOTROPIA

Definition

• Convergent misalignment of the visual axis
• Concomitant
  • Infantile esotropia
  • Accommodative esotropia
• Incomitant
  • 6th nerve palsy

Epidemiology

• Occurs in 2% of American children 1-3 years old;
• No gender difference;
• Most common strabismus of childhood (60%);Z
• Amblyopia is commonly associated with esotropia. ±

Infantile (or congenital) esotropia

• • Equal sex *distribution;
• Present by 6 months of age;
• Family history of strabismus is common;
• Incidence is higher in patients with a history of prematurity, cerebral palsy, hydrocephalus, and other neurological disorders;
• Maternal cigarette smoking and low birthrate have also been linked to the development of esotropia1.

Physical examination:

• Present by 6 months of age;
• Large angle of esodeviation (usually ≥ 30 prism diopters
• Cycloplegic refractions similar to those of normal children of the same age (low hyperopia).
• Often cross-fixation with equal visual acuity in each eye;
• Apparent abduction deficit (pseudoparesis)

eso laterally

Treatment:

Nonsurgical:

• Correct amblyopia before surgery (patching, atropine eye drops)
• Cross-fixation suggests equal visual acuity of both eyes
• Glasses (rarely necessary)

Surgical: mainly

• Surgical alignment earlier than age 2 is associated with better sensory binocular fusion

Look at the corneal light reflex!

eso lateral normal central right str

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Accommodative esotropia

• Convergent deviation of the eyes associated with activation of the accommodation reflex;
• Onset usually between ages 2 and 3
• Often, positive family history;
• May be intermittent at onset;
• Associated with amblyopia (generally from anisometropia);
• May be precipitated by trauma or illness;
• High hyperopia (range +3.00 to +10.00; average: +4.00D).Z

due to high accomidation, only solution is glasses -

OSPE - accomidated ESO - treatment with glasses

• May be partial or total

Treatment:

• Full hyperopic correction
• Treat amblyopia (patching, atropine eye drops)
• If residual strabismus > 10 prism diopters: SURGERY

Look at the corneal light reflex!

R- +10 +9

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6th nerve palsy

• Incomitant esotropia (esotropia varies in different fields of gaze);

Congenital 6th nerve palsy is uncommon: - Usually resolves spontaneously within 6 weeks; - Thought to be caused by increased ICP associated with the birth process;

• Trauma and neoplastic disorders are the most common cause;

• Neurologic evaluation and CT or MRI recommended;

• Surgery is indicated when spontaneous resolution does not take place after 6 months or more of follow-up and after exclusion of intracranial lesions.

SYMPTOMS

• Esotropia
• Horizontal diplopia: 1. Uniocular 2. Painless 3. Increase on looking towards the lateral side.

Signs

• 1. Limitation of abduction
• 2. Esotropia in primary position
• 3. Uncrossed horizontal diplopia: increased towards the paralyzed side.
• 4. Slight face turn towards the side of diplopia