Esotropia with High AC/A Ratio Treatment & Management
- Author: Chris Noyes, MD, FAAFP; Chief Editor: Hampton Roy, Sr, MD more...
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]
Surgery may be required if the esodeviation becomes refractory to optical treatment. Surgery often is needed when optical treatment is delayed. 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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