Esotropia Flashcards by Beth Wilkinson

What is the definition of esotropia?

manifest deviation with misalignment resulting in an inward turn of one eye

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What are the main types of esotropia?

Primary
Secondary
Consecutive
Residual

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What are the types of intermittent esotropia?

Accommodation related
Distance related
Time related
Non-specific

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What is fully accommodative esotropia?

Over convergence due to uncorrected high hyperopic refractive error
ESOT results due to fusional reserves not coping

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When does fully accommodative esotropia usually onset?

18 months-2.5 years

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What refractive error is usually found on cycloplegic refraction of a child with fully accommodative esotropia?

+3.00 to +6.00D

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How should a fully accommodative esotropia be managed?

Full rx: eliminates accommodation and reduces convergence in order to reduce eso, allowing fusion
Treat amblyopia

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When corrected, what does a fully accommodative esotropia become?

Intermittent esotropia

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When corrected, what should a fully accommodative esotropic px have?

BSV
No deviation

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What makes amblyopia more likely in a child with fully accommodative esotropia?

Longer time before correction

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Why can’t strab surgery be performed on a px with fully accommodative esotropia?

Would overcorrect at distance, creating an exotropia at distance.

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What is convergence excess esotropia?

Esotropia at near due to high AC/A ratio
No squint at distance (BSV present)

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When does convergence excess esotropia usually onset?

2-5 years

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What is the management for convergence excess esotropia?

Bifocals to eliminate accommodative convergence
Surgery to reduce AC/A ratio

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What does a high AC/A ratio mean?

Amount of convergence for every dioptre of accommodation is increased

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Is a child with convergence excess esotropia likely to be amblyopic?

No - because they are straight at distance so should have equal VA and BSV some of the time.

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What is near esotropia?

ESOT at near
Straight and BSV at distance
Not related to refractive error or accommodation

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How can you differentiate between near esotropia and convergence excess esotropia?

+3.00D on CT: near ESOT will stay deviated, conv excess will become straight

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What is the management for distance related esotropia?

Surgery if cosmetically poor

Are pxs with distance related esotropia likely to have amblyopia?

No - straight and have BSV at one distance.

How can you differentiate between a distance ESOT and a 6th nerve palsy?

Distance ESOT: full motility, no diplopia (suppressed), BSV at near
6th nerve palsy: often small ESOT at near, limited abduction, horizontal diplopia if acute

What is cyclic esotropia?

ESOT which presents at regular intervals (e.g. every other day)
BSV when straight

Is a px with cyclic esotropia likely to be amblyopic?

No due to periods of BSV

What is the management for cyclic esotropia?

Surgery

What is non-specific esotropia?

ESOT which doesn't conform to a pattern Can be large ESOP decompensating intermittently

How should non-specific esotropia be managed?

Full correction of hyperopia Surgery Exercises to improve fusional reserves

What is constant esotropia with an accommodative element?

Large ESOT which increases at near Often IO overaction

When does constant esotropia with an accommodative element onset?

18 months-3 years

What refractive error is usually present in constant esotropia with an accommodative element?

+3.00 to +6.00D

How should constant esotropia with an accommodative element be managed?

Fully correct - will reduce angle but not completely get rid Treat amblyopia Surgery if cosmetically poor (suppression still present)

What is infantile esotropia?

Large angle ESOT (>30^) which is unrelated to refractive error and doesn't have an accommodative element. Alternates with cross fixation Abnormal OKN persists after 6 months old (would normally resolve)

When does infantile esotropia usually onset?

Before 4 months

Is a px with infantile esotropia likely to be amblyopic?

Unlikely due to alternation but not impossible Poor BSV prognosis

What can be associated with infantile esotropia?

Dissociated vertical deviation Nystagmus Overacting IO Abduction limitation Alternating squint

What is dissociated vertical deviation?

Occluded eye drifts up when dissociated Alternating - each eye will come down to fix on CT Both eyes elevate if both covered

What is cross fixation?

Using the opposite eye to fixate when it's already in a convenient position to do so e.g. using left eye to look right

How should infantile esotropia be managed?

Correct significant refractive error Treat amblyopia Assess BSV potential Botox or surgery to stop muscle contraction

What is nystagmus block?

Large, variable angle ESOT in px with congenital nystagmus from attempting to reduce nystagmus by converging in order to increase VA. Miosed pupils. Often AHP present.

Will a px with nystagmus block have amblyopia?

Often

How should nystagmus block be managed?

Correct refractive error Treat amblyopia Surgery (unpredictable)

What is sensory esotropia?

Uni or bilateral esotropia secondary to vision loss/impairment.

When is vision loss likely to have occured in sensory esotropia?

6 months to 7 years

Is a px with sensory esotropia likely to be amblyopic?

Yes due to poor VA

How should sensory esotropia be managed?

Treat cause of vision loss Assess cosmetic appearance Botox or surgery (can be unpredictable)

What is consecutive esotropia?

ESOT after surgery to correct EXOT/P. Often intentional to allow for natural divergence of eyes.

How should consecutive diplopia be managed if it wasn't planned?

Relieve diplopia with prisms Treat amblyopia Prescribe plus rx if previously not prescribed (would have made more exo before surgery) Further surgery to correct (restore BSV, return to suppression scotoma, improve cosmesis)