Infantile Esotropia Workup

Updated: May 20, 2021
  • Author: Vicente Victor Dizon Ocampo, Jr, MD; Chief Editor: Donny W Suh, MD, MBA, FAAP, FACS  more...
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Perform the alternate prism cover test to accurately measure the angle of strabismus. This procedure gauges the full magnitude of any combined esotropia and esophoria. Carefully perform a prism cover testing for both distance and near fixation in primary position, with the patient wearing any prescribed spectacle correction. Measurement of the strabismus also is carried out in side and vertical gazes to rule out restriction, palsy, and significant oblique muscle overaction or underaction.


Imaging Studies

Autimated and semi-automated methods of strabismus measurements have recently been developed and validated. These systems were created to provide more objective, faster, and easier alternatives to the manual measurements of strabismus. Such manual measurements are largely dependent on the examiner's skill and experience, especially in more challenging patients such as babies and toddlers. Various attempts have been made towards reducing the variability of manual measurements by standardization through automation including the use of automated image analysis software, videos based on infrared eye tracking, video goggles to perform a Hess screen test, and binocular optical coherence tomography.

A modality based on eye tracking and dedicated full occlusion glasses was developed and tested in chidlren with strabismus. It appeared to be a promising tool for providing precise detection and measurements of ocular misalignment and differentiating between phorias and tropias for children aged 3 years and above. Meanwhile, a semi-automated Hirschberg test-based application was similarly tested for horizontal strabismus, with favorable potential.