Update on accommodative esotropia

Robert P Rutstein
Optometry: Journal of the American Optometric Association 2008, 79 (8): 422-31

PURPOSE: The aim of this study was to present an update on accommodative esotropia.

METHODS: The diagnosis, clinical features, etiology, treatment, prognosis, and clinical course for the 3 types of accommodative esotropia are presented.

RESULTS: Accommodative esotropia is the most common pediatric strabismus and must be differentiated from other pediatric esotropias. Although its average age of onset is 2.5 years, it can begin during the first year of life and is seen rarely in older children and teenagers. Refractive accommodative esotropia and nonrefractive accommodative esotropia have a better prognosis for achieving normal binocular vision and high-grade stereopsis with appropriate and timely treatment than partly accommodative esotropia. Children with successfully treated accommodative esotropia need to be followed up with to prevent possible deterioration and development of a superimposed nonaccommodative esotropia, which in some cases may require extraocular muscle surgery. Emmetropization and spontaneous resolution of the esotropia occur rarely and may take many years.

CONCLUSION: Approximately 50% of all pediatric esotropias are either entirely or partly accommodative. Proper care is long term and includes monitoring the refractive error and binocular vision status over the years.

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