Non surgical management of esotropia Flashcards
(32 cards)
What is the intended learning outcome regarding non-surgical management of esotropia?
To describe non-surgical management in constant and intermittent types of esotropia.
This includes discussing refractive correction, prisms, orthoptic exercises, and other treatments.
Name the types of constant esotropia.
- Constant ET without accommodative element
- Infantile ET
- Acquired non-accommodative ET
- Late-onset (normo-sensorial)
- Early-onset (6 months – 2 years)
- Acquired ET with myopia
- Nystagmus block syndrome
- Micro-ET
- Primary constant esotropia
Includes both fully accommodative and non-accommodative types.
What are the types of intermittent esotropia?
- Primary Intermittent Esotropia
- Accommodative
- Fully Accommodative ET
- Convergence Excess ET
- Cyclic ET
- Distance ET
- Near ET
- Non-specific
Each type has different management approaches.
What are the general aims of non-surgical management in esotropia?
- Correct refractive error
- Treat amblyopia and visual acuities
- Further non-surgical management, e.g., orthoptic exercises, observation, BT injections
- Surgical management for ocular alignment and restoring BSV
What is the purpose of full hypermetropic correction?
To relieve excessive accommodative demand when hypermetropia is corrected.
Plus lenses relax accommodation, aiding in the management of accommodative esotropia.
What is the significance of cycloplegic refraction in the management of esotropia?
To prescribe full hypermetropic prescription and monitor the angle of deviation.
It is essential for achieving optimal visual acuity and managing the condition.
Fill in the blank: The threshold of hypermetropia to correct in early onset esotropia is _______.
+2.25D and greater
What are the potential outcomes of poor compliance with glasses wear in children with accommodative esotropia?
Poorer binocular (sensory and motor) outcomes long-term.
Studies indicate that non-compliance leads to worse visual results.
What are the indications for the use of bifocals in accommodative esotropia?
- Minimum plus required for near viewing
- Executive bifocals that bisect the pupil
- Gradually reduce bifocal segment strength over time
True or False: Contact lenses are more discreet than glasses.
True
What are the advantages of contact lenses in managing accommodative esotropia?
- More discreet than glasses
- Remove peripheral blur
- Improved BVA and ocular alignment
- Suitable for older children with good hygiene
Motivation from the child and parents is crucial for successful contact lens wear.
What is the role of miotics in the management of convergence excess esotropia?
To cause spasm of the ciliary body, reducing the need for accommodative effort and eliminating over-convergence.
What should be done if amblyopia is present in a patient with esotropia?
- Part-time total occlusion (PTTO)
- Atropine penalisation +/- optical penalisation
Amblyopia requires specific treatment to improve visual acuity.
What is the purpose of orthoptic exercises in the management of esotropia?
- Eliminate suppression
- Recognition of diplopia
- Improve convergence and control of deviation
What are the long-term treatment results of accommodative esotropia as per Mohan K and Sharma A?
- 79% had orthophoria or esotropia ≤10Δ at 10 years
- 13% had consecutive exotropia
- 5% had decompensated
- 3% had high AC/A ratio esotropia
What is the recommended frequency for repeat refraction in children with esotropia?
Annually, or as needed.
What is the primary aim of orthoptic exercises?
To eliminate suppression and recognize diplopia when the deviation is manifest
This includes improving control of deviation and enhancing convergence abilities.
What conditions must a patient meet for suitability in orthoptic therapy?
- Sufficient age and intelligence to cooperate
- Motivated and able to attend regularly
- Hypermetropia ≤ +3.00DS
- Angle of deviation <25ΔBO sgls
- Some control evident for near/distance
- AC/A ratio not too high (<10:1)
High AC/A ratios are often associated with convergence excess esotropia.
What type of treatment is needed to eliminate suppression in patients?
Anti-suppression treatment
This is necessary to appreciate pathological diplopia when it is manifest.
Name some options for anti-suppression treatment.
- Coloured filters (R-G goggles/Sbisa Bar)
- Septum
- Vertical prisms
These options help in addressing light suppression and improving visual perception.
What is the goal of achieving fusion of diplopia?
Spontaneous control of deviation sgls
This involves finding the point of intersection and gradually withdrawing the target to encourage the patient to maintain fusion.
What does the term ‘CBA’ stand for in the context of orthoptic therapy?
Convergence Near Acuity
CBA is crucial for assessing a patient’s ability to maintain clear vision at near distances.
How can negative relative convergence be improved?
- Exercise BI-range
- Distance stereograms
These exercises help increase negative relative vergences and improve near CBA.
Fill in the blank: Orthoptic exercises should be performed regularly ______.
2-3 x daily
Regular follow-up appointments are necessary to ensure exercises are carried out correctly.
