Esotropia

• What is Esotropia (SOT)?

  Inward deviation of the eye
• What are the key investigations for Esotropia?

  • Family history of hyperopia or strabismus
  • Birth history (prematurity, oxygen, low birth weight)
  • General health (febrile illness, medication, allergies)
  • Previous ocular history (occlusion therapy, eye exercises, surgery)
  • VA measurement appropriate for age
  • Cover test for differentiation
  • Ocular motility examination
  • Cycloplegic refraction
  • Fundus examination
  • BSV investigation (assess retinal correspondence, diplopia, suppression, fusional reserve, stereopsis, angle, AC/A)
• What is the onset age for Infantile Esotropia?

  Before 6 months
• What must be differentiated from Infantile Esotropia?

  6th nerve palsy
• What is the angle of deviation in Infantile Esotropia?

  Usually greater than 30 dioptres
• What is Amblyopia in the context of Esotropia?

  Might be found and prevented by alternation
• What is Dissociated Vertical Divergence (DVD)?

  Eye elevates and extorts under cover
• What is the onset age for Nystagmus?

  Manifest latent nystagmus develops early
• What is Compensatory Head Posture (CHP)?

  Face turn to reduce nystagmus
• What is the management for Amblyopia in Esotropia?

  Amblyopia treatment and surgery
• What is the most common type of Esotropia?

  Infantile SOT
• What characterizes Non-accommodative Esotropia?

  Refractive error is insignificant
• What is the onset age for Late onset Esotropia?

  2 to 8 years
• What happens to diplopia in Late onset Esotropia?

  Moves to suppression rapidly
• What is the management for Late onset Esotropia?

  Surgery once deviation is stable
• What is the AC/C ratio in Convergence Excess Esotropia?

  Greater than 6:1
• What is the management for Convergence Excess Esotropia?

  Correct refractive error and surgery
• What is the management for Near Esotropia?

  Surgery ONLY
• What is the management for Distance Esotropia?

  Surgery ONLY
• What is Fully Accommodative Esotropia?

  Deviation corrected by hypermetropia correction
• What is the onset age for Fully Accommodative Esotropia?

  2-3 years
• What is the management for Fully Accommodative Esotropia?

  Fully correct refractive error
• What happens with high levels of uncorrected hypermetropia?

  May exceed limits of accommodative system
• What are the management options for Esotropia?

  • Surgical options:
  • Medial Recti for near
  • Lateral Recti for distance
  • Recessions weaken muscles
  • Resections strengthen muscles
  • Botulinum Toxin for muscle paralysis
  • Functional cure aims to restore BSV
  • Cosmetic cure aims to improve appearance
  • Refractive options:
  • Fully correct refractive error
  • Full-time glasses wear
• What is the purpose of the post-operative diplopia test?

  Determine suitability for surgery
• What indicates a poor candidate for surgery in the post-operative diplopia test?

  Reports diplopia after 1 prism
• What indicates a good candidate for surgery in the post-operative diplopia test?

  Complains after neutralization or overcorrection
• What are the differences between functional and cosmetic cures in Esotropia management?

  • Functional Cure:
  • Aiming to restore BSV
  • Cosmetic Cure:
  • Aiming to improve cosmetic appearance
• What is the prognosis for fully accommodative Esotropia?

  Prognosis is excellent
• What might parents comment about control in fully accommodative cases?

  Control worsens initially