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.
refraction and fundus examination
Hirschberg light reflex test
monocular abduction attempt
face turn examination
infantile accommodative esotropia
congenital fibrosis syndrome (fixed strabismus)
congenital six nerve palsy
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)
if residual esotropia persists(about 15PD)surgery on the unoperated lateral muscle shoud be done
sometimes adduction may be lower after surgery
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.