Comitant Esotropia

Abstract

• Age of onset, duration of the condition, and neurologic status are important factors in determining the response to surgery and the binocular sensory outcome.

• Congenital esotropia is actually “very early acquired” esotropia. Intermittency may be present initially, but only for a brief period.

• Accommodative esotropia typically begins at about age 2−2.5 years, but earlier onset is not uncommon.

• Quantitative determination of the AC/A ratio is not necessary for management. The distance-near alignment comparison remains useful as an approximation of the AC/A ratio.

• Decompensation of accommodative esotropia can occur through delayed diagnosis, poor compliance, or despite timely and excellent management.

• Decompensated esophoria has a later and more gradual onset, unlike the acute esotropia that should raise the suspicion of serious neurologic disease.

• Undercorrected esotropia after surgery done for appropriate reasons requires completion of treatment, once it is certain that resulting alignment is not within 8 prism diopters of orthotropia.

• Initial overcorrection of exotropia is appropriate surgical strategy, but persisting overcorrection is a risk to a good binocular sensory result.

• Cyclic esotropia is distinguished from other forms of intermittent esotropia by its relatively late onset, repetitive cycle length, and lack of dependence on accommodative effort. Surgery is effective before or after the deviation becomes constant.

• Divergence insufficiency can either describe an unusual setting for esotropia characterized by the distance deviation being greater than that at near, or an acute presentation with diplopia suggesting a serious neurologic abnormality.