Case of the week 14 ( November 2011
) Consecutive esoxotrpia
The mother of this 3.5 years old
child said that her son was operated at the age of 11 months for infantile esotropia
.Conjunctival scars which are seen medially are mostly
of BMR recession , he wore hypermetropic glasses in the order of +6 soon after he
was operated . Refraction showed he is in need for this
glasses prescription , it is +8 using full cycloplejic
refraction .
The child is noted, by his mother, that his eyes deviate . When I
asked her " What is the direction of this deviation Ma'm
? " ,
she answered" sometimes turn inward and sometimes turn outward
" !! .
As you know most mothers can't describe
the nature of strabismus of their sons' eyes but
when I examined him I found an amazing , unusual , very
interesting deviation . Really , I wonder what is the
name of this
disorder ?? Is it an esotropia in an exotropic
child ? Is it an exotropia in an esotropic
child or is it esoxotrpia ?!!! , the deviations
noticed in these photos are the same with
glasses
See video examination of this patient
This
patient resembles a good example of consecutive
XT if the surgeon advocates the bad idea of
surgically treating the refractive
accommodative ET .
The most propminent feature that I noticed about
this patient is the refractive error of +6D
in both eyes and he is not wearing his glasses.
Moreover he is 6/9 approximately uncorrected.
Based on this along with his variable alignment
going from ET to XT, my conclusions are the
following:
1. This boy probably had refractive accommodate
ET before his surgery.
2. A BMR recession changed his basic alignment
and produced an XT that would be present when no
accommodative effort was being expended .
3. The boy uses a huge accommodative convergence
effort to bring his eyes inward from the EXO
deviated position and overshoots the marks, some
producing a small angle variable ET .
At this point my suggestion is that to put him
in his full plus correction. If he does not
tolerate this, I'll use atropine or some type of
cycloplegic that would make it comfortable for
him to wear glasses. After he has become
accustomed to the highest plus correction and
has established a stable baseline deviation
which will undoubtedly be XT , I can do surgery
to align the eyes. Of course a BMR advancement
and resection would be a good choice although
many surgeons still do BLR recession to correct
consecutive ET .
الموقع المصري ل��حول
وامراض الجهاز الحركي للعين
The Egyptian Site of
Strabismus & Oculomotor Disorders
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