Esotropia, Accommodative Treatment & Management

  • Author: Chris Noyes, MD; Chief Editor: Hampton Roy Sr, MD   more...
 
Updated: Feb 22, 2010
 

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 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, Kansas City

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  Assistant Professor of Ophthalmology, Jules Stein Eye Institute; Chief of Section of Ophthalmology Surgical Services, Department of Veterans Affairs Healthcare Center, West Los Angeles

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, 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.

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.

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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