CASE 6A

A 16 month old patient enters your office (with the help of both parents). History is positive for esotropia within the first 6 months of life. The parents want to know what their options are.

History

Family Hx	Positive for ET in 1 (of 4) siblings, same sibling has "lazy eye" and wore thick glasses before surgery
Surgical Hx	Surgeries conducted on sibling @ 20 months and 2 years. Parents satisfied with cosmesis
Onset/Clinical Course	Started @ 6 months; seems to turn in more frequently in past 3 months (no photos); more frequent with near viewing
Laterality	Both eyes turn in; but mostly right eye
Previous Treatment	No VT or surgery on patient. Patient's first eye exam

1. Any additional history?

Objective findings

Mohindra retinoscopy	O.D.: +2.25 DS O.S.: +3.00-1.25 X 090
Acuities	Minimum binoc acuities 20/60 (Teller)
Cover test (entering)	Alternate (E)T 18D; Alternate ET' 35D no resistance to occlusion with either eye; unusual vertical movement noted behind occluder (* see movie #1)
Cover test (SRx)	Alternate (E)T 12D; Alternate ET' 15D no resistance to occlusion with either eye
EOM	Appearance of Hypertropia on adducting eye O.U.; horizontal angle smaller on upward gaze; no nystagmus noted

1. Any additional tests?

Cover test
Fusion tests

2. Any ideas on prescription of spectacles?

3. What would you tell these parents about surgical alternatives?

4. What would be your suggestions for PASSIVE orthoptics for a 16 month old?

5. What would be you suggestions for ACTIVE orthoptics for a 16 month old?

6. How would therapy options change if the child was a 4 year old preschooler with the same condition?