eMedicine Specialties > Ophthalmology > Extraocular Muscles

Esotropia, Acquired: Follow-up

Author: Antonio Pascotto, MD, Consulting Ophthalmologist, Istituto Diagnostico Varelli, Clinica Mediterranea, Napoli, Italy
Coauthor(s): Mauro Fioretto, PhD, Professor and Program Director, Department of Ophthalmology, Ospedale Santo Spirito, Casale Monferrato (AL), Italy; Sergio Claudio Saccà, PhD, Professor of Ophthalmology, Department of Neurological and Visual Sciences, Ospedale San Martino, Italy; Vincenzo Orfeo, MD, Head, Operating Unit, Clinica Mediterranea, Naples, Italy
Contributor Information and Disclosures

Updated: Oct 16, 2006

Follow-up

Further Outpatient Care

  • Regular follow-up care is indicated to monitor the patient's eye alignment.
  • Relief from the eventual diplopia may be achieved through prismatic correction, and the deviation may then resolve spontaneously. Botulinum toxin or surgical intervention may be necessary in cases that do not resolve.

Complications

  • The most common complication associated with surgery for acquired esotropia is unsatisfactory alignment. Surgery usually is performed on the unoperated horizontal muscles in an effort to reestablish binocular function.

Prognosis

  • Binocular sensory function is usually severely compromised by even brief periods of abnormal binocular experience during the first year of life.

Patient Education

  • The prognosis, as well as advantages and disadvantages of the various modes of treatment, should be discussed with the patient's parents and/or the patient, and a plan should be developed based on this dialogue.

Miscellaneous

Medicolegal Pitfalls

  • Prompt detection and treatment are necessary to prevent development of amblyopia and/or loss of binocular vision.
  • Awareness of the mechanism esotropia may avoid referrals to other specialties (eg, neurology).
  • Awareness of the treatment modalities may encourage patients to seek appropriate help for relief of their symptoms.

Special Concerns

  • In parallel with more detailed studies of clinical populations, continued experimental work is needed to characterize the developmental plasticity of the specific neural mechanisms involved in strabismus. These include mechanisms of stereoscopic vision and visual sensitivity to pattern and form and the role of ocular proprioception.
  • An important goal in the ensuing years is to study the mechanisms of binocular vision in individuals with and without esotropia. Binocular vision is both easy to disrupt and difficult to restore after a period of anomalous visual experience, but the neural basis for these properties is unknown.
  • Researchers need to improve upon the methods of detecting strabismus in infants and young children, and, once detected, they must continue to learn how to effectively treat these abnormalities to ensure optimal visual development. Discovering new diagnostic and surgical techniques for the evaluation and treatment of patients with strabismus is important and deserving of continued study.
  • Photographic, video-based, and optoelectronic techniques are being developed for semiautomatic or automatic detection of refractive errors, strabismus, and amblyopia in infants and young children. These methods must be developed further to be cost-effective for mass screening.
  • Automated eye tracker–based measurement of strabismus in not limited children in different directions of gaze is a worthy goal for technology development.
 


More on Esotropia, Acquired

Overview: Esotropia, Acquired
Differential Diagnoses & Workup: Esotropia, Acquired
Treatment & Medication: Esotropia, Acquired
Follow-up: Esotropia, Acquired
References
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References

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  3. Costello PA, Simon JW, Jia Y, Lininger LL. Acquired esotropia: subjective and objective outcomes. J AAPOS. Jun 2001;5(3):193-7. [Medline].

  4. Firth AY. Heroin and diplopia. Addiction. Jan 2005;100(1):46-50. [Medline].

  5. Fukai S, Arai N, Hayakawa T, Kimura H. Studies on the botulinum therapy for esotropia improvement of retinal correspondence. Nippon Ganka Gakkai Zasshi. Jun 1993;97(6):757-62. [Medline].

  6. Goldman HD, Nelson LB. Acute acquired comitant esotropia. Ann Ophthalmol. Dec 1985;17(12):777-8. [Medline].

  7. Jang GJ, Park MR, Park SC. Bilateral lateral rectus resection in patients with residual esotropia. Korean J Ophthalmol. Dec 2004;18(2):161-7. [Medline].

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  9. Ludwig IH, Smith JF. Presumed sinus-related strabismus. Trans Am Ophthalmol Soc. 2004;102:159-65; discussion 165-7. [Medline].

  10. Lyons CJ, Tiffin PA, Oystreck D. Acute acquired comitant esotropia: a prospective study. Eye. Oct 1999;13 (Pt 5):617-20. [Medline].

  11. Mohney BG. Common forms of childhood esotropia. Ophthalmology. Apr 2001;108(4):805-9. [Medline].

  12. Mohney BG. Acquired nonaccommodative esotropia in childhood. J AAPOS. Apr 2001;5(2):85-9. [Medline].

  13. Repka MX, Wentworth D. Predictors of prism response during prism adaptation. Prism Adaptation Study Research Group. J Pediatr Ophthalmol Strabismus. Jul-Aug 1991;28(4):202-5. [Medline].

  14. Thomas AH. Divergence insufficiency. J AAPOS. Dec 2000;4(6):359-61. [Medline].

  15. Troost BT, Abel L, Noreika J, Genovese FM. Acquired cyclic esotropia in an adult. Am J Ophthalmol. Jan 1981;91(1):8-13. [Medline].

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Further Reading

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Keywords

acquired esotropia, acute esotropia, cyclic esotropia, progressive esotropia with myopia, nonaccommodative esodeviation, acquired nonaccommodative esotropia, ANAET, esotropia associated with impaired sight, sixth nerve palsy, abducens nerve palsy, infantile esotropia, diplopia, concomitant esotropia, atypical strabismus,

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Contributor Information and Disclosures

Author

Antonio Pascotto, MD, Consulting Ophthalmologist, Istituto Diagnostico Varelli, Clinica Mediterranea, Napoli, Italy
Disclosure: Nothing to disclose.

Coauthor(s)

Mauro Fioretto, PhD, Professor and Program Director, Department of Ophthalmology, Ospedale Santo Spirito, Casale Monferrato (AL), Italy
Disclosure: Nothing to disclose.

Sergio Claudio Saccà, PhD, Professor of Ophthalmology, Department of Neurological and Visual Sciences, Ospedale San Martino, Italy
Disclosure: Nothing to disclose.

Vincenzo Orfeo, MD, Head, Operating Unit, Clinica Mediterranea, Naples, Italy
Vincenzo Orfeo, MD is a member of the following medical societies: American Academy of Ophthalmology
Disclosure: Nothing to disclose.

Medical Editor

Michael J Bartiss, OD, MD, Medical Director, Ophthalmology, Family Eye Care of the Carolinas
Michael J Bartiss, OD, MD is a member of the following medical societies: American Academy of Ophthalmology, American Academy of Pediatrics, American Association for Pediatric Ophthalmology and Strabismus, American College of Surgeons, and North Carolina Medical Society
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

J James Rowsey, MD, Former Director of Corneal Services, St Luke's Cataract and Laser Institute, Florida
J James Rowsey, MD is a member of the following medical societies: American Academy of Ophthalmology, American Association for the Advancement of Science, American Medical Association, Association for Research in Vision and Ophthalmology, Florida Medical Association, Pan-American Association of Ophthalmology, Sigma Xi, and Southern Medical Association
Disclosure: Nothing to disclose.

CME Editor

Ralph Garzia, OD, Assistant Dean for Clinical Programs, Associate Professor, School of Optometry, University of Missouri at St Louis
Ralph Garzia, OD is a member of the following medical societies: American Academy of Optometry and American Optometric Association
Disclosure: Nothing to disclose.

Chief Editor

Hampton Roy Sr, MD, Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences
Hampton Roy Sr, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, and Pan-American Association of Ophthalmology
Disclosure: Nothing to disclose.

 
 
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