REFRACTIVE ACCOMMODATIVE ESOTROPIA;

Management and results

Abstract

Purpose: To determine the efficacy of all time wear of full cycloplegic correction in the management of refractive
accommodative esotropia. Design: Descriptive study using non-probability purposive sampling technique. Setting: Ophthalmology OPD
and Department of Nishtar Hospital, Multan. Period: Oct 2009 to Sep 2010. Material and Methods: All children with accommodative
esotropia associated with hyperopia were included in the study. The features studied were ocular alignment, association of anisometropia
with strabismus and amblyopia, improvement in deviation of squint after amblyopia therapy and full cycloplegic hyperopic correction
and regain of binocular single vision and requirement for surgery in patients with accommodative esotropia with hyperopia. Results:
Forty four children with refractive accommodative esotropia were identified. Cycloplegic refraction was done for all patients and full
cycloplegic correction was given. At presentation 36.4% of children were amblyopic in either eye and most of them had anisometropic
hypermetropia. The esotropia was present in more hypermetropic eye. 63.6% of the patients became straight with glasses only and
another 25% became straight after amblyopia therapy. Fusion with gross stereopsis was demonstrated in 75% of patients. Cycloplegic
refraction remained stable throughout the follow up period. None of these patients was able to discontinue glasses and maintain
alignment. Surgery was required in only 11.4% of total patients. Conclusions: Most children with refractive accommodative esotropia
have an excellent outcome in term of visual acuity, ocular alignment and binocular single vision with the glasses. Full cycloplegic
correction and amblyopia therapy resulted in marked reduction in the deviation of squint and improvement in visual acuity of the
amblyopic eye as compared with the prevalence at presentation. The degree of hyperopia remains unchanged with poor prospect for
discontinuing glasses wear.