Esotropia Case Study

Esotropia forms the largest group of clinical cases in infants and young individuals presenting to a squint clinic. Parents of the infant are quite apprehensive about the inward turning of the eye(s). Our role as ophthalmologists lies in differentiating the accommodative esotropia from other types. This article focuses on accommodative type of esotropia. Salient clinical features, associated risk factors and treatment protocol for accommodative esotropia shall be discussed in detail. The key to proper management is thorough evaluation and establishing a correct diagnosis.
Incidence
Esotropia is the commonest type of squint in childhood and adolescence. According to Western literature1, esotropia is present in about 61%

First, we have the binocular system that maintains the alignment of both the eyes. Secondly, the accommodative system brings about the desired changes in the eyes for correct focusing of the object. There is a fine balance between these systems as amount of accommodation is just enough to converge the eyes inwards and hence, produce a clear image of the desired object. Sometimes, when there is a significant refractive error (mostly hypermetropia) the child tries to clear the image and inturn accommodates more. This disturbs the fine tuning of the above mentioned system and refractive accommodative esotropia develops. However, not all children with high hypermetropic error develop esotropia. The other factor that determines whether the child will develop a manifest deviation or will remain esophoric is the fusional divergence amplitude. This factor negates the effect of accommodative convergence i.e. a child with insufficient fusional divergence amplitude will have unopposed accommodative convergence and with result, a manifest inward deviation. On the other hand, if the divergence amplitudes are within normal limits, the child will be

It may be feasible to initiate decrease in spectacle power at a younger age and possibly achieve natural emmetropization mechanism. Also, the fusional divergence amplitudes fail to develop in patients who are wearing full hyperopic correction throughout their life. So, it is important to reduce the refractive correction in a gradual and phased manner. However, process of weaning of glasses may precipitate amblyopia and esotropia. Thus, it becomes very essential to make the parents aware about the treatment plan so that the regularity of follow up visits is