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Congenital, infantile, or
essential infantile esotropia is the most common
form of strabismus with onset during infancy for
which no difficulty in diagnosis should be
present.
Congenital (infantile)
esotropia can be confirmed by the clinician at
the age of 4 months . The required findings for
diagnosis are:
1.
Esotropia which is usually of a large angle.
2.
Normal neurologic infant.
3.
Refractive error expected for age and correction
of which does not eliminate esotropia.
Congenital esotropia is
defined as an esotropia appears in the first 6
months of life in a neuorologically normal
infants with bilateral normal eyes.
The infant with congenital
ET has either alternation or fixation preference
for one eye, implying amblyopia. Other findings
may be present - but not needed for diagnosis -
are: manifest nystagmus, latent nystagmus,
oblique muscle dysfunction,DVD and face turn.
Congenital
esotropia is not the only ET with an onset
during the first 6 months of life. There are
other conditions, some are congenital which is
present at birth, and others are acquired which
appear during the first few months of life, like
congenital esotropia.
Among the congenital
conditions: congenital 6th nerve
palsy, Duane syndrome type I, and Mobius
syndrome.
Among the acquired
conditions: sensory esotropia, refractive
esotropia,
the nystagmus compensation (blockage) syndrome,
or esotropia in association with other central
nervous system manifestations, such as Down
syndrome, albinism, cerebral palsy and mental
retardation.
Although there is a huge
debate about the origin and terminology of
congenital esotropia, it is universally accepted
by strabismologists that surgery is the
treatment of choice for congenital ET after
refractive ET is ruled out and after amblyopia (if
present) is treated.
Infants with congenital ET
should alternate fixation before surgery,
however, amblyopia therapy can be continued
after surgery.
The age chosen for surgery
varies from one doctor to another, for me I
prefer interference as early as the age of 4
months .
Surgery for infantile
esotropia consists of bimedial rectus recession,
medial rectus recession and lateral rectus
resection of one eye, a three-muscle procedure
combining a bimedial rectus recession with a
resection of one lateral rectus or in a very few
cases a four-muscle procedure consisting of a
bilateral recession-resection.
Many cases of infantile
esotropia who are operated at age less than 1
year may develop inferior oblique overaction
months to years after initial horizontal muscle
surgery in which case inferior oblique weakening
is done as a second procedure.
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