Esodeviations



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Clinical findings:


  • age of onset between 2-3 years old

  • intermitent at onset then becoming constant

  • average esotropia 20-40 PD nearly the same to distance and near fixation

  • refraction range of +3,o to +10.0D

  • amblyopia is common

  • low accommodative convergens to accommodation ratio (AC/A)

Investigation:


  • full cycloplegic retinoskopy with atropine(3-4days)

  • Hirschberg or Krimsky light reflex test

  • cover test

  • visual test and checking fixation to evaluated amblyopia

Differential diagnosis:

Treatment:


  • full correction of the refractive error

  • constant wearing of the glasses(Ryc.6 and Ryc.7)

  • cure the amblyopia

  • monitor the vision and fixation to make sure the amblyopia does not return

  • anticholinesterase drops shoul be used if non-compliant with glasses

  • orthoptic exercises

Prognosis:


The complete cure with bifoveal fusion will be achieved in patients unless:

  • diagnosed and treated soon after the onset

  • amblyopia and suppression can be eliminated

  • fusion and stereopsis strongly estabilished than the onset is over 3 years old

  • adults have a chance to give up the glasess


NONREFRACTIVE ACCOMMODATIVE ESOTROPIA

(HIGH AC/A RATIO, CONVERGENCE EXCESS)


This condition is characterized by overconvergence associated with accommodation.

Clinical findings:

  • age of onset between 2 mouth-5 years old

  • esodeviation is greater at near than at distance

  • refraction is over +2,o D or myopic

  • amblyopia is common

  • high accommodative convergens to accommodation ratio (AC/A)

Investigation:


  • full cycloplegic retinoskopy with atropine(3-4days)

  • Hirschberg or Krimsky light reflex test

  • cover test

  • visual test and checking fixation to evaluated amblyopia

  • clinical evaluation of distance and near deviation

  • binocular vision tests

Differential diagnosis:


  • congenital esoptropia

  • refractive accommodative esotropia

  • partial accommodative esotropia

  • divergens insufficiency

  • persistent esotropia

  • non-comitant strabismus

Treatment:

Prognosis:


  • amblyopia and suppression can be eliminated

  • try to wean off bifocals after 8 years old patients

  • good fusion in distance with straight eyes or small angle esotropia

Fig.9 Bifocal glasses with +3 Dsph addition at near reduced convergence excess .



Fig.10 Full correction of squint with glasses at distant.


PARTIAL ACCOMMODATIVE ESOTROPIA
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