EARLY ONSET CONSTANT ESOTROPIA

Question 1

Characteristics of Early Onset SOT?

Answer 1

Age = (6 months – 2 years old)

• Characteristics: N=D, Amblyopia common, Poor BSV prognosis, Dev may increase c time, Surgery often needed.

Question 2

Investigations of Early Onset Esotropia?

Answer 2

• Case History
• VA (reduced in dev eye?)
• CT
• OM (check no lateral incomitance – same size L + D version)
• PODT
• BSV Potential: Prisms (split ^ between EE, come back in 1 wk and may have BSV!)
• Synoptophore
• BTxA
• Neuroradiological Investigation

Question 3

What are the Aims in management of Early Onset SOT?

Answer 3

• Obtain optimum or equal VA
• Restore normal BSV if possible
• Early onset = Although previous BSV experience, rarely able to recover – strabismic amblyopia high
• Improve cosmetic appearance if no potential for BSV

Question 4

Management of Early onset SOT?

Answer 4

• Same as for constant esotropia with accommodative element
• Refraction
• Treat amblyopia
• Assess for BSV potential
  o Botulinum Toxin A
  o PAT
  o PODT

Question 5

Surgery for Early onset SOT :

Answer 5

• BSV potential
  o Aim to correct ET fully
• Poor BSV potential
  o Only indicated if cosmesis poor
  o Undercorrect leaving residual ET 5-8∆