residual esotropia

Question 1

what is a consecutive esotropia?

Answer 1

pre-op = exotropia, post-op = esotropia

Question 2

What is residual SOT?

Answer 2

Esotropia remaining after surgery for a larger esotropia (planned or unplanned)

Question 3

When is management required in residual sot?

Answer 3

• Aesthetically unacceptable
• Cannot be controlled with motor fusion

Question 4

Why would you plan for residual sot?

Answer 4

Advised in patients who:
* Risk of developing consecutive XT
o High + or dense amblyopia

• Left with insuperable diplopia if fully corrected
  o PAT
  o Diagnostic BT
• Two stage surgery due to large angle

Question 5

What is management for unplanned residual sot?

Answer 5

Early:
* Check refraction
O Hypermetropia patients to wear full + all waking hours
O Overcorrect temporarily to achieve BSV

• BT injection early postoperatively
• Base-out prisms when BSV potential
  O Aim to reduce prism strength
  O May need to incorporate
   Angle too small for re-operation
   Unable to reduce prism strength further

Late
Depends on success of early interventions
* Bifocals - + patients with BSV in distance
* Incorporated prisms

Question 6

Further surgery for residual eso?

Answer 6

• Residual of 15-20Δ awkward size surgically
• Better result by operating on muscles not previously operated on
• Better result if re-operation within 3 months of original surgery
• Take into account any restrictions
• Appearance factors:
  o IPD
  o Size of refractive error (high +)
  o AHP – can improve appearance
  o Facial asymmetry
  o Associated vertical deviation