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When does infantile esotropia present? What are its clinical features?
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How common is infantile or congenital esotropia? Does it resolve on its
own?
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What is the cause of this
condition?
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Does it run in families?
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Are there other associated
problems?
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What is the best treatment for this condition? When is the optimum time to
intervene?
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Can this be cured with
one surgery?
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How do I get more information?
As the name implies, this
condition occurs during infancy. It may present at birth but most cases
present within the first six months of life.
Characteristically, this type of
deviation shows a large angle of deviation, so large that either eye may
appear unable to move sideways and may even use the head to look at objects
in the peripheral field of vision. The child usually shows a strong
preference of fixation with one eye indicating the presence of amblyopia.
This occurs in about half of cases. When amblyopia sets in, the child has
poor prognosis for high-grade stereopsis.
A small transient exodeviation is
common children at birth but esodeviation is rare in newborns. Any
persistent esotropia beyond 2 months of age usually will not resolve
spontaneously.
The cause is probably
multifactorial.
There is no consistent pattern of
inheritance for this condition. Although there is no family history in some
cases, there is a tendency for it to occur in families.
Other abnormalities of muscle
functions can occur with infantile esotropia. These include dissociated
vertical deviations, inferior oblique overactions, and nystagmus. The first
two tend to occur much later than the initial eye deviation. This is one
reason why some children had to undergo a second surgery.
Infantile esotropia is not
uncommon in children with cerebral palsy and Down’s syndrome.
The deviation is best treated
with surgery. The standard procedure is to do this between 6 months and 2
years of age to in order to achieve peripheral fusion (1). However, some
authors found that doing surgical intervention earlier than 6 months of age
may result to good alignment and high-grade stereopsis (2). Early surgery
is indicated when the amount of deviation is very large (40 prism diopters
or larger), and when the deviation is found to be becoming constant or
increasing in amount documented in two consecutive visits several weeks
apart. Of course, the child has to be healthy enough to undergo the surgery
under general anesthesia. Spontaneous resolution is a possibility in small
deviations; however, it is highly unlikely to happen in large deviations.
A single procedure may align the
eyes if the amount of deviation is not very large. More than 2 muscles may
be involved in very large deviations. Half of the cases need multiple
surgeries to achieve perfect alignment.
Sources:
Ing MR. Early surgical
alignment for congenital esotropia. Ophthalmology. 1983; 90: 132-135.
Wright KW et al. High-grade
stereoacuity after early surgery for congenital esotropia. Archive
Ophthalmol. 1994; 112: 913-919.
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CONGENITAL ESOTROPIA information compiled by
Dr. Barbara L. Roque and initially uploaded on December 05, 2005.
Last updated on
September 19, 2007.
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