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Accommodative Esotropia Treatment & Management

  • Author: Chris Noyes, MD, FAAFP; Chief Editor: Hampton Roy, Sr, MD  more...
 
Updated: Jul 26, 2016
 

Medical Care

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.

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Surgical Care

Surgery may be required if the esodeviation becomes refractory to optical treatment. Surgery often is needed when treatment is delayed.[4]

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.

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Contributor Information and Disclosures
Author

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

Chris Noyes, MD, FAAFP is a member of the following medical societies: American Academy of Family Physicians, Texas Medical Association, 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: Nothing to disclose.

Specialty Editor Board

Simon K Law, MD, PharmD Clinical Professor of Health Sciences, Department 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, Association for Research in Vision and Ophthalmology, American Glaucoma Society

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, Sigma Xi, Southern Medical Association, Pan-American Association of Ophthalmology

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, Pan-American Association of Ophthalmology

Disclosure: Nothing to disclose.

Additional Contributors

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, American Ophthalmological Society

Disclosure: Nothing to disclose.

Acknowledgements

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. 2008 Aug. 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. 2009 Feb. 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. 2008 Aug 27. [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. 2009 Mar-Apr. 19(2):188-95. [Medline].

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