Accommodative Esotropia Treatment & Management
- Author: Chris Noyes, MD, FAAFP; Chief Editor: Hampton Roy, Sr, MD more...
Prescription of the full amount of hyperopic correction provides adequate treatment for refractive (accommodative) esotropia in 75% of cases.[2, 3]
Anticholinesterase drops or ointments in patients with a normal AC/A ratio are not as effective as glasses.
In cases of amblyopia, early treatment by patching the normal eye is the mainstay of treatment.
Surgery may be required if the esodeviation becomes refractory to optical treatment. Surgery often is needed when treatment is delayed.
Surgical treatment typically entails recession or weakening of the inward-pulling medial rectus muscle in each eye. In cases involving amblyopia, surgery can be limited to only the amblyopic eye by performing a recession of the medial rectus and a resection or strengthening of the lateral rectus.
Surgery is performed for the nonaccommodative component only. The operation is not intended to discontinue use of glasses.
Rutstein RP. Update on accommodative esotropia. Optometry. 2008 Aug. 79(8):422-31. [Medline].
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. 2009 Feb. 147(2):357-63. [Medline].
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. 2008 Aug 27. [Medline].
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. 2009 Mar-Apr. 19(2):188-95. [Medline].
Birch EE, Wang J. Stereoacuity Outcomes After Treatment of Infantile and Accommodative Esotropia. Optom Vis Sci. 2009 Apr 22. [Medline].
Beers MH, Berkow R. The Merck Manual of Diagnosis and Therapy. 1999.
Berson FG. Basic Ophthalmology for Medical Students and Primary Care Residents. 1993.
Catalano RA, Nelson LB. Pediatric Ophthalmology: A Text Atlas. 1994.
Helveston EM, Ellis FD. Pediatric Ophthalmology Practice. 1980.
Kunimoto DY, et al. The Wills Eye Manual: Office and Emergency Room Diagnosis and Treatment of Eye Disease. 2004.
Wright KW, et al. Pediatric Ophthalmology and Strabismus. 1995.