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ESOTROPIA
ASHITH TRIPATHI
Directed by -
Guided by -
priti yadav mam
CONCOMITANT ESOTROPIA
 That is, an inward squint that does not vary with
the direction of gaze.
 Concomitant esotropia can itself be subdivided
into esotropias that are –
1. Stage of latent esodeviation
2. Stage of intermittent esodeviation
3. Stage of constant esodeviation
ESOTROPIA
 It is a form of strabismus in which one or both eyes turned
inward.
 The condition can be constantly present, or occur intermittently,
and can give the affected individual a ‘cross – eyed’ appearance.
CLASSIFICATION
1. Infantile ( congenital ) esotropia
2. Accommodative esodeviation
3. Acquired non – accommodative esotropia
4. Sensory esotropia
5. Consecutive esotropia
Infantile esotropia
 Infantile esotropia is a distinct clinical form of esotropia
which usually presents at 1-2 months of age. However, it
may be detected shortly after birth or any time within the
first 6 months of life. Previously, It was known as
‘congenital esotropia’.
ETIOLOGY
 It is not associated with hyperopia, so the exertion of
accommodation effort will not significantly affect the
angle of deviation.
 Role of accommodation - it has also been reported that
an accommodative element may be responsible partially or
wholly in some cases of infantile esotropia.
 General and environmental factors include low birth
weight, prematurity, perinatal hypoxia, maternal –
smoking, drugs, and alcohol abuse.
CLINICAL FEATURES
 Time of onset
 Angle of deviation
 Fixatation pattern
 Visual acuity
 Refractive errors
MANAGEMENT
Management of a case of infantile esotropia can be considered
under following heads:
 Clinical evaluation and differential diagnosis -
 Examination of anterior segment
 Estimation of visual acuity
 Examination of fundus and media
 Refraction under atropine cycloplegia
 Measurment of AC/A ratio
 Measurement of deviation
 Diffrenciation from simulated bilateral sixth nerve paralysis
 Non- surgical treatment –
 Correction of refractive error
 Treatment of amblyopia
Surgical treatment –
 Time of surgery
 Choice of surgery
ACCOMMODATIVE
ESOTROPIAS
 Accommodative esotropia refers to esotropia which is
caused by over convergence in response to
accommodation.
Characteristics:
 Onset age is usually between 2-3 years.
 Esodeviation is usually intermittent at onset becoming
constant with passage of time.
 Often hereditary
 Precipitated sometimes by trauma or illness.
 Amblyopia is frequently associated.
Types –
Depending upon mechanism of occurrence –
 Refractive accommodative esotropia ( high hyperopia with
normal AC/A ratio )
 Non – refractive accommodation esotropia ( high AC/A )
ratio
 Hypoaccommodative esotropia
 Mixed or partially accommodative esotropia
Clinical evaluation and diagnosis –
measurement of deviation
Cycloplegic refraction
Measurement of fusional divergence
amplitude
Examination of fundus and ocular media
TREATMENT
 Optical correction –
 Full optical correction given
 Role of atropinization
 Importance of full time wear of spectacle correction
 Role of miotics
 Amblyopia therapy
 Orthoptic treatment
 Role of surgery
Non – refractive
accommodative esotropia
 It refers to that type of accommodative esotropia which is
caused by a high AC/A ratio and thus the esotropia is
significantly greater at near than distance fixation.
 It is unrelated to refractive error and the near point of
accommodation is normal for the age of the patient.
 Clinical characteristics
 Time of onset
 Ocular deviation
 AC/A ratio
 Development of sensory adaptations
Clinical evaluation and
diagnosis
 Measurement of deviation
 Cycloplegic refraction
 Measurement of AC/A ratio
 Examination of fundus and ocular media
Treatment –
 Amblpopia therapy
 Bifocal glasses
 Miotics
 Orthoptic exercises
 surgery
Sensory esotropia
 It refers to the esotropia which develops due to poor visual
function in one eye in the childhood.
Clinical type –
 Monocular visual loss
 Deviation
 Amblyopia
Treatment
 Surgical treatment is usually required to improve cosmetic
appearance.
Consecutive esotropia –
 Consecutive esotropia refers to occurrence of esotropia in
an eye which was previously exotropia.
 It has been reported to occurs under following two clinical
situations:
1. Surgical overcorrection of exotropia
2. Spontaneous consecutive esotropia
Esotropia Types and Management

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Esotropia Types and Management

  • 1. ESOTROPIA ASHITH TRIPATHI Directed by - Guided by - priti yadav mam
  • 2.
  • 3.
  • 4. CONCOMITANT ESOTROPIA  That is, an inward squint that does not vary with the direction of gaze.  Concomitant esotropia can itself be subdivided into esotropias that are – 1. Stage of latent esodeviation 2. Stage of intermittent esodeviation 3. Stage of constant esodeviation
  • 5. ESOTROPIA  It is a form of strabismus in which one or both eyes turned inward.  The condition can be constantly present, or occur intermittently, and can give the affected individual a ‘cross – eyed’ appearance.
  • 6. CLASSIFICATION 1. Infantile ( congenital ) esotropia 2. Accommodative esodeviation 3. Acquired non – accommodative esotropia 4. Sensory esotropia 5. Consecutive esotropia
  • 7. Infantile esotropia  Infantile esotropia is a distinct clinical form of esotropia which usually presents at 1-2 months of age. However, it may be detected shortly after birth or any time within the first 6 months of life. Previously, It was known as ‘congenital esotropia’. ETIOLOGY  It is not associated with hyperopia, so the exertion of accommodation effort will not significantly affect the angle of deviation.
  • 8.  Role of accommodation - it has also been reported that an accommodative element may be responsible partially or wholly in some cases of infantile esotropia.  General and environmental factors include low birth weight, prematurity, perinatal hypoxia, maternal – smoking, drugs, and alcohol abuse. CLINICAL FEATURES  Time of onset  Angle of deviation  Fixatation pattern  Visual acuity  Refractive errors
  • 9. MANAGEMENT Management of a case of infantile esotropia can be considered under following heads:  Clinical evaluation and differential diagnosis -  Examination of anterior segment  Estimation of visual acuity  Examination of fundus and media  Refraction under atropine cycloplegia  Measurment of AC/A ratio
  • 10.  Measurement of deviation
  • 11.  Diffrenciation from simulated bilateral sixth nerve paralysis
  • 12.  Non- surgical treatment –  Correction of refractive error  Treatment of amblyopia
  • 13. Surgical treatment –  Time of surgery  Choice of surgery
  • 14. ACCOMMODATIVE ESOTROPIAS  Accommodative esotropia refers to esotropia which is caused by over convergence in response to accommodation.
  • 15.
  • 16. Characteristics:  Onset age is usually between 2-3 years.  Esodeviation is usually intermittent at onset becoming constant with passage of time.  Often hereditary  Precipitated sometimes by trauma or illness.  Amblyopia is frequently associated. Types – Depending upon mechanism of occurrence –  Refractive accommodative esotropia ( high hyperopia with normal AC/A ratio )  Non – refractive accommodation esotropia ( high AC/A ) ratio  Hypoaccommodative esotropia  Mixed or partially accommodative esotropia
  • 17. Clinical evaluation and diagnosis – measurement of deviation Cycloplegic refraction Measurement of fusional divergence amplitude Examination of fundus and ocular media
  • 18.
  • 19. TREATMENT  Optical correction –  Full optical correction given  Role of atropinization  Importance of full time wear of spectacle correction  Role of miotics  Amblyopia therapy  Orthoptic treatment  Role of surgery
  • 20. Non – refractive accommodative esotropia  It refers to that type of accommodative esotropia which is caused by a high AC/A ratio and thus the esotropia is significantly greater at near than distance fixation.  It is unrelated to refractive error and the near point of accommodation is normal for the age of the patient.  Clinical characteristics  Time of onset  Ocular deviation  AC/A ratio  Development of sensory adaptations
  • 21. Clinical evaluation and diagnosis  Measurement of deviation  Cycloplegic refraction  Measurement of AC/A ratio  Examination of fundus and ocular media Treatment –  Amblpopia therapy  Bifocal glasses  Miotics  Orthoptic exercises  surgery
  • 22. Sensory esotropia  It refers to the esotropia which develops due to poor visual function in one eye in the childhood. Clinical type –  Monocular visual loss  Deviation  Amblyopia
  • 23. Treatment  Surgical treatment is usually required to improve cosmetic appearance. Consecutive esotropia –  Consecutive esotropia refers to occurrence of esotropia in an eye which was previously exotropia.  It has been reported to occurs under following two clinical situations: 1. Surgical overcorrection of exotropia 2. Spontaneous consecutive esotropia