This document discusses the evaluation and management of esotropia in children. It begins by defining esotropia as inward turning of one or both eyes. It then describes the different types of esotropia including esophoria, intermittent esotropia, and constant esotropia. For evaluation, it recommends assessing visual acuity, stereopsis, ocular alignment and motility. Management involves treating any amblyopia or refractive error first through non-surgical means such as glasses, patching, or botulinum toxin injection. For persistent esotropia, surgical options include recession or resection of the medial or lateral rectus muscles. The document outlines approaches for different types of esotropia
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EVALUATION AND MANAGEMENT OF ESOTROPIA IN CHILDREN
1. EVALUATION OF ESOTROPIA IN
CHILDREN
Asso Prof Dr. Khair
Ahmed Chowdhury
Dr. Chandan Kumar
Paul
Dr. Sadia Yeasmin
Saki
2. INTRODUCTION
The term is derived from 2 greek words: Eso
meaning inward & Trepo meaning turn
50% of ocular deviation in pediatric age group
In Esotropia, the eyes are crossed, that is one eye
looks straight ahead, other eye is turns in toward
the nose
9. B. Incomitant esotropia
6th nerve palsy
Medial wall fracture
Congenital fibrosis of extraocular muscle
Duane retraction syndrome
Mobius syndrome
10. MANAGEMENT
# History taking :
History taking from parents :-
1.Prenatal : Period of gestation
Problems in utero
Drug history ( alcohol)
TORCH
2.Postnatal :
LBW
Septicemia
11. HISTORY..
Age of onset
Duration
Uni ocular / binocular
Association:
Headache
Discomfort / AHP
Blurring of vision
Double vision
13. HISTORY…
History of acquired paresis:
- Trauma
- Neurological disease
Previous ocular history:
- Use of spectacles
- Occlusion therapy
- Any surgery
14. SYMPTOMS
Blurring of vision
Discomfort
Diplopia
Cosmetic embarrassment / AHP
Intermediate duration at the time of stress
and inattention
15. CLINICAL EXAMINATION
Careful VA assessment
Test for stereopsis:
Titmus
Frisby
Lang
Measument of vergence:
Synaptophore
RAF rule
Test for sensory abnormality:
Worth 4 dot test
4d prism test
16.
17. CLINICAL TEST..
Test for ocular deviation:
Hirschberg’s corneal reflex test
Bruckner’s test
Krimsky test
Cover uncover test
Prism bar cover test
Ocular motility test
Diplopia test
hess chart
18.
19. CLINICAL TEST..
Cycloplegic refraction :
by retinoscope
Slit lamp evaluation for anterior segment
Dilated fundus examination
Examination under anaesthesia
23. SURGICAL TREATMENT
Time of surgery:
• Between 6 months to 2 years of age
• Wait up to 6 months of age in intermittent
esotropia or small to moderate angle
deviations
24. Before proceeding to surgery:
• Deviation should be constant and stable
• Fixation should be alternating
• Sensory esotropia should have been ruled
out
• Amblyopia should be treated optimally
• Counselling with parents.
25. SURGICAL APPROACHES
• Bilateral Medial Rectus recession
• Ipsilateral MR recession with LR resection
• Muscle surgery-combination of recession and
resection
• Adjustment of vertical muscles-Weakening IO
28. INFANTILE ESOTROPIA
It is an idiopathic esotropia
Developed within first 6 months of life
No significant refractive error
No limitation of ocular movement
30. INITIAL TREATMENT
Either recession of both MR
Unilateral MR recession with LR resection
Associated significant IO over action should
be addressed
38. TREATMENT OF REFRACTIVE ACCOMMODATIVE
ESOTROPIA
Medical Management :
Full Hypermetropic correction : under
cycloplegia – revealed on Retinoscopy
Spectacles ; full time
Gradual reduction of hypermetropic correction;
if binocular fusion is maintained.
Amblyopia correction
Counselling
40. Surgical treatment
If spectacle dose not full correct the
deviation
1. Bilateral medial rectus- Recessions
performed with or without posterior
fixation
41. 2. If no significant difference between
distance and near , equal vision in both eye
- MR recession combined with LR resection
Or bilateral medial rectus recession.
42. MICROTROPIA
It is a small angle (<10 )
Treatment
- correction of refractive error
- occlusion for amblyopia
43. NEAR ESOTROPIA (NON ACCOMMODATIVE
CONVERGENCE EXCESS)
Older children and young adult
Treatment:
- Bilateral MR recessions
50. FOLLOW UP
At each visit evaluate amblyopia
measure the degree of deviation with
prism
In the absence of amblyopia the child
is re evaluated in 3-6 weeks after a
new prescription is given.
51. TAKE HOME MESSAGE
Esotropia produces profound deficit in
binocular vision if not address in
proper time
Proper recognition, early treatment
and appropriate counselling can
provide most successful outcome