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Infantile Esotropia

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Ophthalmology – Strabismus: By Yi Ning Strube M.D.

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Volume 15 , Issue 4 December Pages Related Information. You notice that one eye seems to turn, and just when you have concluded which one it is, the other eye seems to be the culprit. Unlike childhood strabismus, the adult type usually creates symptoms, such as double vision diplopia , which may be accompanied by nausea. What Is a Phoria? It is only a tendency, and it is usually kept under control so that the eyes appear normal and work together normally.

The misalignment can be unmasked by covering either one of the eyes.

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Phorias are named in the same way as tropias: esoPHORIA tendency for one eye to turn in , exophoria out , hyperphoria up , and hypophoria down. Most phorias cause no symptoms at all. But if the phoria is large, great effort may be needed to keep the eyes aligned and working together - to avoid seeing double - and this may cause eyestrain and headache. Sometimes, when the strabismus is intermittent, the eyes stay aligned and appear straight some of the time, but lapse into strabismus at other times.

The tropia is more likely to occur late in the day, in the bright outdoors, or when you are ill. As the years go on, intermittent strabismus tends to become more constant and less intermittent. The eyes should be examined as soon as you even suspect that they might be crossing or wandering, no matter how small the misalignment might be.

No child is too young to be seen and early care can prevent later heartache.

Refractive Accommodative Esotropia

The sooner treatment is begun, the better your child's chance for achieving normal vision in each eye and good binocular depth perception. Correction after the age of 6 or 7 is more difficult and the result less satisfactory. Goals of Treatment. For children, your doctor will try to achieve normal appearance, good vision in each eye with or without glasses , binocular vision, and depth perception.

In adults, the goals are binocular vision which eliminates double vision and relief of any discomfort. If an adult has a childhood strabismus that was never treated, it is too late to improve any amblyopia or depth perception, so the goal may be simply cosmetic -- to make the eyes appear to be properly aligned -- though sometimes treatment does enlarge the extent of side vision. Eyeglasses, with or without patching, are often tried first and can usually reduce the amount of deviation.

This is especially true for accommodative esotropia, a type of strabismus in which farsightedness is a major part of the problem. Eyeglasses can be worn by infants as young as a few months. The glasses must usually be worn constantly, often for life.

Convergent strabismus: Synonyms in English

If surgery is thought necessary, it is designed to correct only the deviation that remains with the glasses on. In cases of slight or intermittent misalignment, orthoptics exercises are occasionally useful, but only in very specific circumstances. Used inappropriately, orthoptics can be wasteful and can lead to delay in starting proper treatment. A patch is placed over the normal preferred eye , to force the use of the deviant amblyopic eye until vision improves and equalizes.

Generally, surgery is postponed until that happens.

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In adults, a patch over one eye is one method of eliminating any double vision. Prisms incorporated into the eyeglasses is another. Surgery consists of tightening some eye muscles and loosening others, to change their pull on the eyeball and bring the eyes into alignment.

Occasionally, a loosening effect can be accomplished without surgery by injecting a paralyzing medication directly into the muscle. Surgery is sometimes performed on infants as young as a few months of age when there is a good chance of obtaining binocular vision. Children require a general anesthetic.