Management of Esotropia Flashcards
(21 cards)
What is Divergence Insufficiency Esotropia?
Magnitude larger at distance than near; low AC/A ratio
What characterizes Basic Esotropia?
Magnitude similar at distance and near; normal AC/A ratio
Define Convergence Excess Esotropia.
Magnitude larger at near than distance; high AC/A ratio
What is Infantile Esotropia?
Early onset; typically before 6 months of age; constant large-angle (>30 PD) with no or mild amblyopia
What are common features of Infantile Esotropia?
- No amblyopia due to alternating esotropia
- Small to moderate hyperopia
- Latent nystagmus (40%)
- Dissociated vertical deviation (70-90%)
- Overactive inferior oblique (70%)
- Abnormal optokinetic reflex
What is Accommodative Esotropia?
Esotropia is greater at near than at distance; early onset between 6 months and 7 years of age
What are the classifications of Accommodative Esotropia?
- Refractive: fully accommodative; uncorrected hyperopia
- Non-refractive: cause is NOT due to uncorrected hyperopia
- Partially Accommodative (Decompensated): residual esotropia despite full hyperopic correction
What defines Non-Accommodative Esotropia?
Essential esotropia acquired comitant esotropia; not associated with accommodative effort
What is Sensory Esotropia?
Occurs before age 2 due to unilateral vision impairment resulting in sensory deprivation
What is the prognosis for Constant Esotropia?
Resolution is rare when angle is ≥ 40 PD; moderate to large angles in early infancy persist in 98% of patients
What factors affect treatment and management of esotropia?
- Age of Onset
- Duration
- Frequency
- Magnitude
- Comitancy
- Sensory Anomalies
- Prior Surgical Treatment
What is the recommendation for occlusion therapy in infants with intermittent esotropia?
Patching as an initial treatment can increase the risk for progression to constant large-angle esotropia
How is Binasal Occlusion applied in unilateral esotropia?
Asymmetric widths of tape; fixating eye is occluded to allow peripheral viewing
What are the prerequisites for Prism Therapy?
- Normal correspondence
- Normal sensory fusion
- Minimal suppression
What is the centration point in relation to esotropia?
The location in space where the visual axes intersect; where estropes are ortho-aligned
What is orthoposition vision therapy?
Emphasizes base-in vergences; work from near to intermediate to far regardless of size of deviation
When is surgical intervention appropriate for esotropia?
When deviation remains 15-20 PD after vision therapy
What are the characteristics of vision therapy for preschoolers with esotropia?
- Use plus lenses including bifocals
- Consider binasal occlusion
- Prism therapy to elicit fusion
What techniques are included in active vision therapy for esotropia?
- Brock string
- Vecto/tranaglyphs
- Eccentric circles
- Lifesaver cards
- Aperture rule
- TV trainer
Fill in the blank: The angle of esotropia is typically larger at ______ than at distance in Convergence Excess Esotropia.
near
True or False: Intermittent esotropia has a better prognosis than constant esotropia.
True
