Strabismus - Fundamentals of Clinical Ophthalmology.pdf

CHILDHOOD ONSET OF STRABISMUS
In adults acute onset of acquired esotropias,
particularly in the absence of a family history
or significant hypermetropia, requires a neurological
examination and neuroimaging. Acquired
esotropia may persist after recovery from a sixth
nerve palsy whether this be isolated or associated
with raised intracranial pressure such as in
benign intracranial hypertension, occasionally
craniostenosis or sagittal sinus thrombosis seen
more commonly in childhood with suppurative
middle ear infections.
For acquired esotropia of sudden onset with
loss of fusion, neurological examination with
neuroimaging, to exclude cerebral neoplasm or
other pathology, is essential.
Fully accommodative
A hypermetropic child who begins to
accommodate from the age of 1–3 years may
develop an esotropia from overconvergence
associated with extra accommodation to correct
the hypermetropic error. Such a strabismus is
defined to be fully accommodative if the optical
correction straightens the eyes completely
(Figure 4.4). Although rare, a child with myopia
may have straight eyes, but with spectacle
correction may present with a manifest esotropia
which is clearly accommodative in origin
(Figure 4.5).
Partially accommodative
A child’s accommodative esotropia reduced
by optical correction but not fully eliminated
at distance or near is defined as partially
accommodative strabismus (Figure 4.6). Such
(a)
(a)
(b)
Figure 4.4 Fully accommodative esotropia in a child.
Note full correction of convergent strabismus by
hypermetropic spectacles
(b)
Figure 4.5 Without glasses (a) the eyes are straight.
With glasses (b) the eyes are convergent because of
the induced accommodative effort to focus
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