Esodeviations



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Clinical findings:


  • esotropia on distance fixation 10-20PD (Fig. 11)

  • orthophoria at near (Fig.12)

  • normal ductions and versions

  • sometimes mild bilateral sixth nerve paresis

Investigation:


  • cover test at near and distance

  • eye movements exam

  • no fusion divergence

  • neurologic examination to evaluate any neurological syndrome, intracranial tumor or head trauma

  • cycloplegic refraction

  • eye fundus evaluation

Differential diagnosis:


  • congenital esotropia

  • acute acquired esotropia

  • following recovered n.VI palsy

  • bilateral sixth nerve paresis

  • incomitant (paralitic) strabismus

Treatment:

Prognosis:

SPASM OF THE NEAR REFLEX

This condition appear periodically and is characterized by an overconvergence associated with accommodation and miosis.Fig13A and 13B.

Fig.13A The child aged 1,8-year-old with spasm of the near reflex.



Fig.13B Spasm of the near reflex on 7-month-old child.


Clinical findings:



  • present from early age

  • large angle esotropia at near

  • good ductions with bad versions

  • sensitive individuals in whom emotions can be seen to play a large part in the severity of esotropia

  • miosis



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