Consecutive Esotropia

Question 1

What is consecutive esotropia?

Answer 1

An esotropia occurring in a patient with a history of exotropia

Consecutive esotropia can develop after surgery or due to other factors.

Question 2

What are the possible reasons for consecutive esotropia?

Answer 2

• Spontaneous (rare)
• Optical (over minus prescription or increasing myopia)
• Post-operative (most common)

Spontaneous cases may be due to various factors, including sudden loss of vision.

Question 3

What does the term ‘spontaneous consecutive esotropia’ refer to?

Answer 3

A rare occurrence where esotropia develops without an apparent cause

Examples include cases documented by Mein (1981) and Raouf (2021).

Question 4

What is the typical timing for post-operative consecutive esotropia?

Answer 4

May happen immediately or many years after the original surgery

Early occurrences can be due to muscle slippage or incorrect positioning.

Question 5

What is the management strategy for planned post-operative consecutive esotropia?

Answer 5

Aim to overcorrect by up to 14PD to produce long-term success

Alignment on the day of surgery is correlated with outcomes.

Question 6

What distinguishes unplanned post-operative consecutive esotropia?

Answer 6

Early types occur immediately or within the first weeks, while late types occur months or years later

Early cases may involve muscle slippage or incorrect positioning.

Question 7

What are common signs of muscle slippage in consecutive esotropia?

Answer 7

• Large esotropia
• Restriction of abduction
• Proptosis

CT scans are advised for further investigation of muscle location.

Question 8

What is the recommended management for a lost muscle in consecutive esotropia?

Answer 8

Re-operate immediately if evidence of a lost muscle is present

Identifying the muscle location may require a CT scan.

Question 9

What are the management options for consecutive esotropia?

Answer 9

• Observation
• Optical / prisms
• Botox
• Surgery

Management is dependent on whether the case is functional or non-functional.

Question 10

What is the purpose of Bangerter foils in the management of consecutive esotropia?

Answer 10

To teach suppression by blurring the vision in one eye

They reduce contrast and help manage diplopia.

Question 11

What factors influence the management of consecutive esotropia?

Answer 11

• Functional vs. Non-functional
• Symptomatic vs. Asymptomatic

These factors help determine the appropriate treatment approach.

Question 12

What is the significance of the relationship between surgical results and alignment on the day of surgery?

Answer 12

High correlation to outcomes at 6 months post-op

Overcorrection on the day of surgery leads to better long-term outcomes.

Question 13

Fill in the blank: The most common type of consecutive esotropia is _______.

Answer 13

unplanned post-operative

This type can occur early or late after surgery.

Question 14

True or False: Consecutive esotropia can develop from a planned surgical correction of intermittent exotropia.

Answer 14

True

Planned surgeries aim for overcorrection to achieve desired outcomes.

Question 15

What clinical features may indicate a slipped muscle in consecutive esotropia?

Answer 15

• Large deviation
• Limited ductions
• Widening of palpebral fissures

These features can help identify issues with muscle positioning.