Infantile esotropia manifests before a child is 6 months old and includes a constant, large angle of strabismus, no or mild amblyopia, latent. Strabismus is one of the most relevant health problems of the world, and infantile esotropia is perhaps the most visually significant yet the least. The term congenital esotropia is often used interchangeably with infantile esotropia, but few cases are actually noted at birth. Often the exact.

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Helveston [2] further clarified and expanded upon von Noorden’s work, and incorporated the work of both Lang and Cianca into his summary of the characteristics of the condition:.

Nystagmus blockage syndrome Patients with nystagmus blockage syndrome will have moderate to large amounts of manifest nystagmus and be orthotropic when inattentive, but will have variable esotropia and mild nystagmus when attentive. Worth [1] theory suggests that there is an irreparable congenital defect in the infant’s visual system and that surgery can be carried out at leisure mostly for cosmetic purposes.

The incidence of overcorrection is low following surgery for infantile esotropia.

Patients with congenital fibrosis of the extraocular muscles will frequently have poor ductions. Ophthalmology Rochester ; Patients with nystagmus blockage syndrome will have moderate to large amounts of manifest nystagmus and be orthotropic when inattentive, but will have variable esotropia and mild nystagmus when attentive.

Penlight Hirschberg corneal reflex test held at 33 cm reveals large angle esotropia inturningwhere the corneal light reflex infanhil temporally displaced. Even though a macular scotoma develops in the non-fixating eye central suppressionbinocular fusion of points in the peripheral retina is retained peripheral fusion. Other less common complications include perforation of the sclera, lost or slipped muscles, infection, anterior segment ischemia, postoperative diplopia, conjunctival granulomas and cysts.


It is essential that a child with strabismus is presented to the ophthalmologist as early as possible for diagnosis and infanhil in order to allow best possible monocular and binocular vision to develop. Age 4 months Visual Acuity without correction OD: CSM central, steady, maintained OS: If there is no oblique dysfunction, shifting the medial rectus muscles at time of recession towards the apex of the pattern will weaken the effective pull of the medial rectus at the apex, decreasing the amount of V or A pattern.

American Association for Pediatric Ophthalmology and Strabismus

Observing the patient for pupillary constriction during the esotropic phase may be helpful in making this diagnosis. Surgery for large angle congenital esotropia. In both enditropia, however, the essential characteristics were the same, but with emphasis placed on different elements of the condition.

Characteristics of infantile esotropia following early bimedial rectus recession. Traditionally, PAT is used in acquired ET to determine the surgical angle and estimate fusion potential. Amblyopia is poor vision in an eye that is structurally normal. Multiple surgeries may be needed to correct large angle esotropia. Most children with infantile esotropia demonstrate a deficit of depth perception when old enough to be imfantil reliably.

However, if farsighted, spectacles may be prescribed. Occasionally a vertical acting eye muscle inferior oblique may overact which may cause the eye to move up when looking to the side.

It is also advised to perform the exam without touching the child if possible. They also have palpebral fissure narrowing of the affected eye on adduction.

Infantile Esotropia — AAPOS

Research done by Eileen Birch and David Stager showed that stereopsis emerges abruptly in the first few months of life but degenerates pathologically within a few months in uncorrected esotropes. Nystagmus is also frequently observed and is usually latent type. Journal of Pediatric Ophthalmology and Strabismus. Two-muscle surgery spares the remaining two horizontal muscles for subsequent surgery should it be needed.


Infantile Esotropia From EyeWiki.

Amblyopia occlusion treatment after the eyes are aligned can interfere with the exercise of binocularity. The same condition had also previously been described by infantiil ophthalmologists, notably Cianca who named it Cianca’s Syndrome and noted the presence of manifest latent nystagmusand Lang who called it Congenital Enrotropia Syndrome and noted the presence of abnormal head postures.

The examination must include assessment of vision, ocular motility, strabismus measurements at distance and near and cycloplegic refraction in addition to general ocular examination.

Many infants may freely alternate their fixation. Surgical complications Sight-threatening complications from strabismus surgery are uncommon. This is a small, rhythmic, horizontal movement of the eyes when one eye is closed or covered. The British Journal of Ophthalmology.

Equally round and briskly reactive. Entire eye Anophthalmia Cystic eyeballCryptophthalmos Microphthalmia. Comparison of pre- and post-operative appearances.

Infantile esotropia

Original article contributed by: Cross fixation often causes the appearance of not looking directly at a target and parents often wonder if vision is reduced. Treatment is spectacles for the full cycloplegic refraction. Enotropia, this term was felt to be an inadequate classification as it covered a variety of esotropias with different causes, features and prognoses.

Last modified: January 23, 2020