Accommodative Esotropia 

  • Author: Chris Noyes, MD; Chief Editor: Hampton Roy Sr, MD   more...
 
Updated: Mar 6, 2012
 

Background

Strabismus is misalignment of the eyes such that both eyes are not simultaneously directed at the same object. Esotropia is a type of strabismus characterized by an inward deviation of one eye relative to the other eye. Accommodative esotropia (refractive accommodative esotropia) is an esodeviation due to normal accommodation in uncorrected hyperopia. The AC/A (accommodative convergence/accommodation) ratio gives the relationship between the amount of convergence (in-turning of the eyes) that is generated by a given amount of accommodation (focusing effort). Amblyopia is reduced visual acuity due to an abnormal visual experience early in life.[1]

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Pathophysiology

A patient with uncorrected hyperopia must accommodate to clear a blurred retinal image. This process of accommodation will stimulate convergence and strain fusional divergence. When fusional divergence is overcome, the eyes cross. The patient with uncorrected hyperopia can see either a single blurred image or a double image in which one image is clear and one image is blurred. Over time, the blurred image can be suppressed; fixation can alternate; or, more commonly, amblyopia can occur.

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Epidemiology

Race

No racial predilection exists.

Sex

No sex predilection exists.

Age

This condition usually presents by the age of 2 years.

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Contributor Information and Disclosures
Author

Chris Noyes, MD  FAAFP, Private Practice - Texas Family Medicine

Chris Noyes, MD is a member of the following medical societies: American Academy of Family Physicians and Texas Academy of Family Physicians

Disclosure: Nothing to disclose.

Coauthor(s)

Raghav R Gupta, MD  Consulting Staff, Department of Ophthalmology, Vista Ophthalmology, Medical Center of Plano, and Presbyterian Hospital of Plano

Disclosure: eMedicine Honoraria Other

Specialty Editor Board

Gerhard W Cibis, MD  Clinical Professor, Director of Pediatric Ophthalmology Service, Department of Ophthalmology, University of Kansas School of Medicine

Gerhard W Cibis, MD is a member of the following medical societies: American Academy of Ophthalmology, American Association for Pediatric Ophthalmology and Strabismus, and American Ophthalmological Society

Disclosure: Nothing to disclose.

Simon K Law, MD, PharmD  Associate Professor of Ophthalmology, Jules Stein Eye Institute, University of California, Los Angeles, David Geffen School of Medicine

Simon K Law, MD, PharmD is a member of the following medical societies: American Academy of Ophthalmology, American Glaucoma Society, and Association for Research in Vision and Ophthalmology

Disclosure: Nothing to disclose.

J James Rowsey, MD  Former Director of Corneal Services, St Luke's Cataract and Laser Institute

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.

Lance L Brown, OD, MD  Ophthalmologist, Affiliated With Freeman Hospital and St John's Hospital, Regional Eye Center, Joplin, Missouri

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.

Additional Contributors

The authors and editors of Medscape Reference gratefully acknowledge the contributions of previous coauthor, D Brian Stidham, MD, to the development and writing of this article.

References

  1. Rutstein RP. Update on accommodative esotropia. Optometry. Aug 2008;79(8):422-31. [Medline].

  2. Li CH, Chen PL, Chen JT, Fu JJ. Different corrections of hypermetropic errors in the successful treatment of hypermetropic amblyopia in children 3 to 7 years of age. Am J Ophthalmol. Feb 2009;147(2):357-63. [Medline].

  3. Cho YA, Yi S, Kim SW. Clinical evaluation of cessation of hyperopia in 123 children with accommodative esotropia treated with glasses for best corrected vision. Acta Ophthalmol. Aug 27 2008;[Medline].

  4. Magli A, Iovine A, Gagliardi V, Fimiani F, Nucci P. LASIK and PRK in refractive accommodative esotropia: a retrospective study on 20 adolescent and adult patients. Eur J Ophthalmol. Mar-Apr 2009;19(2):188-95. [Medline].

  5. Birch EE, Wang J. Stereoacuity Outcomes After Treatment of Infantile and Accommodative Esotropia. Optom Vis Sci. Apr 22 2009;[Medline].

  6. Beers MH, Berkow R. The Merck Manual of Diagnosis and Therapy. 1999.

  7. Berson FG. Basic Ophthalmology for Medical Students and Primary Care Residents. 1993.

  8. Catalano RA, Nelson LB. Pediatric Ophthalmology: A Text Atlas. 1994.

  9. Helveston EM, Ellis FD. Pediatric Ophthalmology Practice. 1980.

  10. Kunimoto DY, et al. The Wills Eye Manual: Office and Emergency Room Diagnosis and Treatment of Eye Disease. 2004.

  11. Wright KW, et al. Pediatric Ophthalmology and Strabismus. 1995.

 
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