ESOTROPIAS

I. Accommodative

1. total, esotropia eliminated

a. refractive

- high hyperopia, bilateral not unilateral

- normal range of AC/A ratio

 

b. innervational

- high AC/A ratio

- low to moderate hyperopia

- primarily near point

c. combined

2. partial, esotropia partially eliminated

a. refractive usually

3. characteristics

a. intermittent deviation

b. variable angle

4. management

a. full correction of hyperopia

b. bifocal Rx

c. long term care

 

II. Non-Accommodative, comitant

1. congenital

a. at birth or very shortly thereafter

2. infantile

b. within 6 months of age

3. acquired

a. childhood - early acquired

b. adult - late acquired

4. management

a. correct refractive error, especially hyperopia

b. orthoptics

c. surgery

III. Microstrabismus

1. < 10 pd deviation

 

2. unilateral

a. amblyopia

- variable magnitude

- EF or CF

3. central suppression

4. peripheral fusion ranges

MONOFIXATION

SYNDROME

5. good local stereopsis

a. 60-70 arc sec

6. harmonious ARC

7. esophoria (monofixational esophoria)

8. special testing

a. Worth 4 Dot

b. 4 pd BO test

9. management

a. embed

b. enhance motor fusion

c. beware esophoria breakdown into intermittent esotropia

10. Microtropia - a special form of microesotropia

(monofixational orthophoria)

a. Ð EF = Ð deviation

b. example

- 2 pd constant OD esotropia, 2 pd OD nasal EF

c. management

- embed

III. Consecutive

1. pre-surgical exotropia --- post-surgical esotropia

IV. Divergence insufficiency / divergence paralysis

1. relatively sudden onset of diplopia at distance in adults

a. esotropia at distance, could be intermittent

2. fusion at near

3. esotropia is comitant

4. reduced BI ranges

5. EOMs full

6. R/O bilateral VI nerve palsy

7. decompensation of functional disorder (high eso at distance)

8. management

a. full plus