FULLY ACCOMMODATIVE ESOTROPIA

Question 1

What is a Fully Accom SOT?

Answer 1

Esotropia without + correction on Accommodation
* Esophoria with + corrected

Question 2

Characteristics of fully accom sot?

Answer 2

• Starts intermittently and becomes more constant, may rub/close one eye, aware of ET more when tired/unwell, Mod degree of hypermetropia (+2.00Ds to 7.00Ds), BSV Nr and Dis when fully corrected, some control to microtropia, AC:A NORMAL !!!, Amblyopia: length of time s gls and level of aniso.
• Onset : 2-5 years old (as increase in near tasks)

Question 3

Investigations in fully accom sot?

Answer 3

• Case history
• Cyclo Refraction and adaptation period (16-18 wks) – give full +
• VA
• CT; light, accom, target, with and without glasses
• BSV
• PCT c & s gls
• OM
• Parents may note ET more noticeable s gls, As older may report dip without glasses

Question 4

What are the two types of treatment in fully accom sot?

Answer 4

• Optical treatment – spectacles and contact lenses
• Orthoptic treatment

Question 5

Management of fully accommodative sot?

Answer 5

Correction of Refractive Error
* Cycloplegic refraction – full + (don’t take off for cyclo)
* Don’t give reduced +
* Refractive adaptation
* Gradual increase in + until 7 years then gradual decrease (Esposito et al. 2018)

Contact Lenses
* Improvement in CBA & angle (fully accomm) – prefer to wait until child old enough to use themselves

Visual Acuity
* Amblyopia found occasionally – those controlling to microtropia
* Usual amblyopia treatment
* Improvement in VA can improve BSV and control

Orthoptic Treatment:
* Small number can regain BSV without correction through exercises
O Suitability: Those with +3.00DS or less, no more than 1.00DC
 Age they can recognise diplopia & cooperate – use vertical prism to show diplopia (1)
 Size of deviation without gls – much less likely with >25∆
 “misty & clear”
 Better control without glasses (2) - Increase fusional vergence – convergence exercises or prism bar
 (3) Increase CBA: nr = bar reading, distance = concave lenses or stereograms
 (4) = reduce strength of + gradually

Surgery:
Not justified unless decompensated