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op3103- bv > 4. Intermittent Esotropia > Flashcards

4. Intermittent Esotropia Flashcards

1
Q

What is esotropia?

A

Manifest deviation where misalignment of the visual axis results in inward turning of one eye.

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2
Q

4 groups of esotropia?

A
  1. Primary (Constant and intermittent)
  2. Secondary/ sensory
  3. Consecutive
  4. Residual
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3
Q

What is Secondary/ sensory esotropia?

A

Strabismus is secondary to another reason e.g. poor VA.

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4
Q

What is consecutive esotropia?

A

Was an exotropia but due to surgery now an esotropia (over correction).

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5
Q

What is residual esotropia?

A

Px had big esotropia but after surgery left with small esotropia.

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6
Q

What is intermittent esotropia and what are the 4 classifications?

A

Esotropia only present under certain conditions, when eyes are straight normal BSV. related to the following classification: Distance, Time, Accommodation, Non-specific.
Most common is related to accommodation.

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7
Q

Risk of amblyopia with intermittent esotropia is high or low?

A

Low risk because px doesn’t need to be straight 24/7 and be binocular for VA to develop normally.

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8
Q

2 categories of intermittent esotropia?

A
  1. Fully accommodative esotropia
  2. Convergence excess esotropia
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9
Q

What is fully accommodative esotropia and what are the characteristics?

A
  • Constant esotropia when hyperopia is uncorrected.
  • Presenting at 18months to 3years.
  • Hyperopic +3 to +6
  • Px is straight when Rx corrected.
  • Management: Wear fully corrected RX, surgery not needed.
  • VA likely to be equal or squinting eye likely to be slightly amblyopic.
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10
Q

What is the max when undercorrecting big plus?

A

+2D

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11
Q

Why is the range for fully accommodative esotropia +3D-+6D?

A

A higher plus (+8D-+10D can’t accommodate readily without RX being corrected). Big plus: the RX is to high to produce an esotropia.

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12
Q

What happens when full correction given to fully accommodative esotropia?

A

Eliminates accommodation and reduces convergence.

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13
Q

Why is slight amblyopia present in fully accommodative esotropia?

A

Prior to dispensing glasses the child will have constant esotropia therefore potential for amblyopia to develop.

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14
Q

What is convergence excess esotropia?
Onset?
Are they likely to be amblyopic?

A

Esotropia at near but straight with BSV at distance. With RX corrected still esotropic at near. Related to high AC/A ratio
Onset: 2-5 yrs.
VA likely to be equal for BEs hence low risk of amblyopia.

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15
Q

Cause of convergence excess esotropia?

A

High AC/A ratio: Hence, accommodating by a normal amount can induce a large amount of accommodation convergence, hence large eso deviation.

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16
Q

Management of convergence excess esotropia- long term & short term

A

Short term: Executive bifocals with a +3.00Add as px is waiting for surgery. This allows the child be binocular and surgery is the permanent way to reduce large AC/A values.

17
Q

What are the 2 classes of intermittent esotropia relating to distance?

A
  1. Near Esotropia
  2. Distance Esotropia
18
Q

What is Near Intermittent esotropia?

A

Esotropia present at near fixation, straight BSV at distance. Unrelated to refractive error or accommodation.

19
Q

What is distance intermittent esotropia?

A

Esotropia present at distance fixation, straight BSV at near. Unrelated to refractive error or accommodation.

20
Q

Management of intermittent esotropia’s relating to distance?

A

Management is usually surgical if cosmesis is poor.

21
Q

How to differentiate near esotropia from convergence excess?

A

Place a +3.00D lens + CT, if angle becomes straight/ phoric– suggests px has a high AC/A ratio hence, convergence excess. With +3 no difference = Near esotropia.

22
Q

How to differentiate between near esotropia and 6th nerve palsy?

A

Bot h have a near esotropia, hence look at motility to differentiate.
6th nerve palsy= When px looks out, limited abduction (Esotropia will be significantly big) of affected eye because lateral rectus in affected eye is weak.
Distance eso = complete full motility.

23
Q

Do you refer a 6th nerve palsy?

A

YES URGENTLY

24
Q

What is cyclic esotropia?
Are they likely to be amblyopic?

A

Esotropia related to time. Esotropia present a regular intervals. Usually requires surgery.
Not likely to be amblyopic because px is binocular at most times.

25
Q

What is non-specific esotropia?

A

No confirmed pattern

op3103- bv (11 decks)

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