This document discusses accommodative esotropia, a condition where excessive accommodation effort causes the eyes to turn inward. It is most often caused by uncorrected hyperopia. If left untreated in a visually immature child, it can lead to loss of binocular vision and amblyopia. Treatment involves full refractive correction through glasses to relax accommodation and restore binocular vision. The timing between onset and treatment determines the visual outcome.

1. Accommodative esotropia
Dr. Rahul

2. Accommodative esotropia
 Accommodative
esotropia is a
condition where in
excessive effort of
accommodation
results in an inward
deviation of the eyes.
 Most often it is caused
by uncorrected
Hypermetropia.

3.  Acquired Esotropia in a visually immature child is a
day time emergency.
 The consequences are loss of Binocular vision & onset
of amblyopia.
 The interval between the time of onset & the
treatment determines the visual outcome

4. Classification
Accommodative
esotropia
Refractive
Accommodative
Esotropia
Non- Refractive
Accommodative
Partially
Accommodative
(Mixed)

5. Fully accommodative
 Accommodative Esotropia which is fully corrected by
optical correction of Hypermetropia is called
Refractive Accommodative Esotropia
 These children will initially be normal with straight
eyes.

6.  Around the age of 18 to 24 months, they try to
accommodate to clear the retinal image blur.

7. **Binocular Vision and Ocular
Mobility: Theory and Management of
Strabismus, Gunter K. Von Noorden

8. Clinical Features
 Onset 2-3 yrs of age; but can occur at any age
 • Initially intermittent & variable
Diplopia
Within 2-3 days suppression
Longer duration leads to Anomalous retinal
correspondence
• Develop amblyopia if uncorrected
• Normal AC/A ratio
• Hypermetropic refractive error (usually between +2 D to+6)

9. Accommodative esotropia
–without & with glasses

10. Treatment
 Full refractive correction is prescribed, so that
binocular vision can be restored.
 Child should wear the refractive correction
at all times.
 If not, child will not relax the accommodation &
vision will be blurred with glasses