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Case of the week 99 ( February 2013 )
Alternating Esotropia
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This 13 years old girl complains of inward eye deviation. She
said that the
condition started since early childhood, family
photographs prove that she was fine till at
least the age of 4 months.
Vision : 6/6 OD
6/6 OS
Normal refraction , Normal fundus
The parents ask for surgical
correction for this ugly deviation.
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Someone whose
squint alternates is very unlikely to
develop amblyopia because both eyes will
receive equal visual stimulation, like
this girl whose VA is 6/6 OU .
Most patients I've met with this type of
ET have a huge angle of deviation and
ugly appearance , they always ask for
surgery to realign their eyes . In most
cases 3 muscles - or even four muscles
- surgery is
needed .
In these patients fixating with both
eyes , measuring the angle with prism
and cover test is usually could be done
easily . Angle measured here is 25 PD ,
surgery done here is BMR recession 4.5
mm . She was satisfied with the result.
Many surgeons fear of diplopia which may
occur post-operative in these cases ,
although I rarely met this
post-operative complaint , but if it
happens , alternating day occlusion for
1 or 2 weeks is enough for such
complaint to disappear . |
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