LATE ONSET CONSTANT ESOTROPIA

Question 1

What are characteristics of late-onset esotropia?

Answer 1

• Onset 2-8+ years
• N = D
• Intermittent – constant large angle
• Diplopia
• NRC
• OM normal
• Minor injury or short period of uniocular occlusion preceding the onset

Question 2

What are Aims of management in late onset SOT?

Answer 2

• Obtain optimum or equal VA
• Restore normal BSV if possible - Late onset = Much more likely
• Improve cosmetic appearance if no potential for BSV

Question 3

Management of Late onset SOT?

Answer 3

• Same as for constant esotropia with accommodative element
• Refraction
• Treat amblyopia (less likely)
• Restore BSV
  o Prisms
  o Botulinum Toxin A
  o Early surgery
   Bilateral MR recession (Clark et al. 1989, most regained BSV)