Esodeviations



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Investigation:

Differential diagnosis:

Treatment:

Prognosis:


Only an early treatment of the congenital esotropia excellent visual acuity in each eye, single binocular vision in all directions of gaze and normal esthetic appearance may be achieved.
NYSTAGMUS BLOCKADE SYNDROM

Then nystagmus begins in early infancy and associated with esotropia it is called nystagmus blockade syndrome.

Fig.5 The 3,5month boy with nystagmus blockade syndrome.


Clinical findings:

Investigation:


  • refraction and fundus examination

  • Hirschberg light reflex test

  • cover-uncover test

  • monocular abduction attempt

  • face turn examination

Differential diagnosis:


  • congenital esotropia

  • infantile accommodative esotropia

  • cyclic esotropia

  • congenital fibrosis syndrome (fixed strabismus)

  • congenital myasthenia

  • congenital six nerve palsy

  • Moebius’ syndrome

Treatment:


  • appropriate eye-glasses or contact lenses

  • botulinum toxin injection

  • large amount of surgery are required; recession of both medials (6-8mm) and resection of one lateral rectus muscle (8-10mm)

Prognosis:


  • if residual esotropia persists(about 15PD)surgery on the unoperated lateral muscle shoud be done

  • sometimes adduction may be lower after surgery
ACCOMMODATIVE ESOTROPIA

Accommodative esotropia is a deviation of the eyes associated with activation of the accommodative reflex. Related to accommodative effort may be divided into 3 categories:1)refractive 2)nonrefractive 3)partial or decompensated.
Refractive accommodative esotropia

(fully accommodative esotropia )

Fig.6 Accommodative esotropia without glasses



Fig.7 Accommodative esotropia is redused with the hyperopic glasses.


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