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Esotropia with High AC/A Ratio Treatment & Management

  • Author: Chris Noyes, MD, FAAFP; Chief Editor: Hampton Roy, Sr, MD  more...
 
Updated: Aug 10, 2015
 

Medical Care

Treatment of nonrefractive accommodative esotropia consists of full correction for the distance refractive error and bifocals for near vision to suspend the accommodative drive and to lessen accommodative convergence.

Bifocal power should be +2.50 to +3.00 diopters, and bifocals should be placed such that the upper boarder of the bifocal segment bisects the pupil. Miotics, which lower the AC/A ratio, are successful in some patients. In cases of amblyopia, early treatment of patching the normal (unaffected) eye is the mainstay of treatment.[3, 4]

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Surgical Care

Surgery may be required if the esodeviation becomes refractory to optical treatment. Surgery often is needed when optical treatment is delayed.[5] Surgical treatment typically entails recession or weakening of the inward-pulling medial rectus muscle in each eye. 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. Campos EC. Why do the eyes cross? A review and discussion of the nature and origin of essential infantile esotropia, microstrabismus, accommodative esotropia, and acute comitant esotropia. J AAPOS. 2008 Aug. 12(4):326-31. [Medline].

  2. Webber AL, Wood JM, Gole GA, Brown B. Effect of Amblyopia on the Developmental Eye Movement Test in Children. Optom Vis Sci. 2009 May 4. [Medline].

  3. Scott AB, Miller JM, Shieh KR. Bupivacaine injection of the lateral rectus muscle to treat esotropia. J AAPOS. 2009 Apr. 13(2):119-22. [Medline].

  4. Rowe FJ, Noonan CP. Botulinum toxin for the treatment of strabismus. Cochrane Database Syst Rev. 2009 Apr 15. CD006499. [Medline].

  5. Polling JR, Eijkemans MJ, Esser J, Gilles U, Kolling GH, Schulz E, et al. A randomised comparison of bilateral recession vs. unilateral recession-resection as surgery for infantile esotropia. Br J Ophthalmol. 2009 Mar 30. [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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