Abstract
Horizontal comitant strabismus forms the single largest group of strabismus we encounter routinely. In spite of their clinical abundance, varied presentation makes this subtype challenging even for an experienced observer.
Broadly speaking, a horizontal comitant deviation could be either esotropia (ET) or exotropia (XT) depending on whether either eye deviates inwards (nasally) or outwards (temporally). The literal meaning of ‘committance’ is to be pledged or to accompany in a subordinate way. Both the eyes (are pledged each other and) have equal deviation in all directions of gaze for a given fixation distance. The seat of anomaly is usually the brain unlike incomitant deviations which arise out of defect in the neuro muscular complex.
Dynamic mechanisms (e.g. accommodation, fusional vergence) may be superimposed or may mask the deviation. Residents often confuse esotropia to be the opposite of exotropia; however, they should be considered as totally different entities.
This is a preview of subscription content, log in via an institution.
Buying options
Tax calculation will be finalised at checkout
Purchases are for personal use only
Learn about institutional subscriptionsReferences
von Noorden GK, Campos EC. Chapter 16: Esodeviations. In: Binocular vision and ocular motility. 6th ed. St. Louis: Mosby; 2002. p. 311–49.
Ogle KN, Martens TG, Dyer JA. Oculomotor imbalance in binocular vision and fixation disparity. Philadelphia: Lea & Febiger; 1967.
Murray C, Newsham D. Normative values for the accommodative convergence to accommodation ratio (AC/A). Invest Ophthalmol Vis Sci. 2010;51:801.
Jackson JH, Arnoldi K. The gradient AC/A ratio: what’s really normal? Am Orthopt J. 2004;54:125–32.
Sen DK, Malik S. Accommodative-convergence over accommodation (AC/A) ratio (in normal Indian subjects). Indian J Ophthalmol. 1972;20:153–7.
Vivian AJ, Lyons CJ, Burke J. Controversy in the management of convergence excess esotropia. Br J Ophthalmol. 2002;86(8):923–9.
Durnian JM, Noonan CP, Marsh IB. The psychosocial effects of adult strabismus: a review. Br J Ophthalmol. 2011;95:450–3.
Olitsky SE, Sudesh S, Graziano A, Hamblen J, Brooks SE, Shaha SH. The negative psychosocial impact of strabismus in adults. J AAPOS. 1999;3(4):209–11.
Mojon-Azzi SM, Kunz A, Mojon DS. Strabismus and discrimination in children: are children with strabismus invited to fewer birthday parties? Br J Ophthalmol. 2011;95:473–6.
Collins ML. Strabismus in cerebral palsy: when and why to operate. Am Orthopt J. 2014;64:17–20.
Ghasia F, Brunstrom-Hernandez J, Tychsen L. Repair of strabismus and binocular fusion in children with cerebral palsy: gross motor function classification scale. Invest Ophthalmol Vis Sci. 2011;52(10):7664–71.
von Noorden GK, Campos EC. Chapter 17: Exodeviations. In: Binocular vision and ocular motility. 6th ed. St. Louis: Mosby; 2002. p. 356–76.
Wright KW, Spiegel PH, Thompson LS. Chapter 8: Exotropia. In: Handbook of pediatric strabismus and amblyopia. New York: Springer; 2006. p. 270–1.
Donders FC. An essay on the nature and the consequences of anomalies of refraction, Oliver CA, editor. Philadelphia: P Blakiston’s Son & Co; 1899. p. 59.
Herman JS, Johnson R. The accommodation requirement in myopia. A comparison of contact lens and spectacles. Arch Ophthalmol. 1966;76:47–51.
Agrawal S, Singh V, Yadav A, Katiyar V. Orthoptic relevance of refractive correction in the phakic plane in unilateral high refractive errors in adults. Oman J Ophthalmol. 2016;9:196–8.
Brown HW. Discussion of paper by Burian HM, Franceschetti AT: Evaluation of diagnostic methods for the classification of exodeviations. Trans Am Ophthalmol Soc. 1970;68:56.
Burian HM, Franceschetti AT. Evaluation of diagnostic methods for classification of exodeviations. Trans Am Ophthalmol Soc. 1970;68:56.
Haggerty H, et al. The Newcastle Control Score: a new method of grading the severity of intermittent distance exotropia. Br J Ophthalmol. 2004;88:233–5.
Baker JD, Schweers M, Petrunak J. Is earlier surgery a sensory benefit in treatment of intermittent exotropia? In: Lennerstrand G, editor. Advances in strabismology, Proceedings of the eighth Meeting of the International Strabismological Association, Maatricht, Dept 10–12, 1988. Buren, The Netherlands: Aeolus Press; 1999. p. 289.
Kelkar JA, Gopal S, Shah RB, Kelkar AS. Intermittent exotropia: surgical treatment strategies. Indian J Ophthalmol. 2015;63:566–9.
Spencer RF, Tucker MG, Choi RY, McNeer KW. Botulinum toxin management of childhood intermittent exotropia. Ophthalmology. 1997;104(11):1762–7.
Etezad Razavi M, Sharifi M, Armanfar F. Efficacy of botulinum toxin in the treatment of intermittent exotropia. Strabismus. 2014;22(4):176–81.
Author information
Authors and Affiliations
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2019 Springer Nature Singapore Pte Ltd.
About this chapter
Cite this chapter
Agrawal, S., Srivastava, R.M., Yadav, A. (2019). Comitant Horizontal Strabismus. In: Agrawal, S. (eds) Strabismus. Springer, Singapore. https://doi.org/10.1007/978-981-13-1126-0_3
Download citation
DOI: https://doi.org/10.1007/978-981-13-1126-0_3
Published:
Publisher Name: Springer, Singapore
Print ISBN: 978-981-13-1125-3
Online ISBN: 978-981-13-1126-0
eBook Packages: MedicineMedicine (R0)