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Squint Free Papers Table 1: Distribution and the angle of deviation of esotropic patients in various groups n=44 Normal Convergence Convergence Excess Total %, (n) Angle of %, (n) Angle of Angle of %, (n) deviation (∆) deviation (∆) deviation (∆) mean±sd (distance) (near) (range) mean±sd mean±sd (range) (range) RAE 40.9% 37.2 ± 10.3 18.2% 40 ±25.2 51.4 ±28.4 59.1% (18) (14-50) (8) (20-100) (30-120) (26) PAE 22.7% 54.5 ± 20.3 6.8% 23.3 ±14.5 43.3 ±7.6 29.5% (10) (35-100) (3) (14-40) (35-50) (13) NAE 11.4% 42 ± 16.9 0, (0) NA NA 11.4% (5) (20-65) (5) Table 2: Age, refractive error and ocular deviation in different groups of esotropia n=44 RAE (n=18) RAE+CE PAE (n=10) PAE+CE NAE (n=5) mean ± sd range (n=8) (n=3) Age (Yrs) 4 ± 2.1 (1-9) 6.5 ±2.4(3-9) 6 ±2.6(1.5-9) 7 ±1.0(6-8) 4.4 ±1.8(2-6) Spherical 6.7 ±1.7 4.6 ±1.5 5.1 ±2.5 3.3 ±1.4 3.8 ±1.4 Eqivalent (3.4-10) (2.3-7.6) (0-10) (1-4.8) (1.8-5.8) (Diopters) Anisometro- 0.7±0.6 0.7±0.6 0.7±0.9 1±2(0-3) 0.6±0.6 pia (Diopters) (0-1.9) (0-1.6) (0-2.8) (0.1-1.5) Cover test (∆) 37.2±10.3 46.9±24.0 54.5±20.3 61.7±20.2 42±16.8 on presentation (14-50) (25-100) (35-100) (50-85) (20-65) NEAR Cover test (∆) 36±10.9 41.7±29.4 55.6±21 55±31.2 37.5±12.6 on presentation (14-50) (20-100) (35-100) (30-90) (20-50) DISTANT Cover test (∆) 0±0(0) 0±0(0) 29.9±9.8 24±14.0 39.6±17.6 under cycloplegia (18-40) (14-40) (20-68) NEAR Cover test (∆) 0 0 27.9±9.8 22.7±15 33.8±9.5 under cycloplegia (18-40) (14-40) (20-40) DISTANT Cover test (∆) 0 13.1±3.8 26.9±9.8 43.3±7.6 38±16.8 with full correction (8-18) (18-40) (35-50) (20-65) NEAR Cover test (∆) 0 0 27.9±9.8 23.3±14.5 32.5±8.7 with full correction (18-40) (14-40) (20-40) DISTANT Cover test (∆) with Not 0 Not 22.7±15.5 Not addition lens Applicable Applicable Applicable 947
948 69th AIOC Proceedings, Ahmedabad 2011 patients with PAE, the deviation measured under cycloplegia was equal to that measured with full refractive correction. In the patients with PAE with CE, the deviation measured under cycloplegia was equal to that measured with full refractive correction with +3.0D addition indicating that cycloplegia abolished the accommodative component of the esotropia. In the patients with NAE, the deviation measured under cycloplegia was same as that with spectacle correction. There was no patient in the sub category of NAE with CE. However, during the study period, there was one child of NAE with CE (nonaccommodative convergence excess) who did not have a refractive error hence he was not included in the study. However, it was interesting to see him orthotropic with the bifocal spectacles but esotropic under cycloplegia. The correlation coefficient for the ocular deviation under cycloplegia and full refractive correction (with +3D addition in the patients with CE) was 1.0. Three patients developed slight fever that required oral medication. None of the patients had severe rash / high grade fever necessitating discontinuation of the atropine. DISCUSSION From the results we believe that the measurement of ocular deviation under cycloplegia in esotropes with hyperopia can predict the effect of spectacle correction on ocular deviation. Under the condition of complete cycloplegia, the accommodative component of the esodeviation is abolished. Whatever deviation persists under cycloplegia, is the non-accommodative component which persists even after the spectacle correction and it is controlled by the fusional divergence or require prisms/squint surgery. Clinicians are well aware that an accommodative esotrope (RAE) often have straight eyes when he/she is not accommodating. As soon as the child tries to resolve, the accommodative convergence manifests into a large esodeviation. The same principle underlies the measurement of ocular deviation under cycloplegia i.e. to abolish the accommodative effort completely. If accommodative efforts persist, esotropia will persist. It is possible that under incomplete cycloplegia, when the child is pressed to read smaller size of the target, an accommodative effort may still be deployed that may manifest into an esodeviation. For the reliable measurement of the ocular deviation, presence of complete cycloplegia is an absolute necessity. We used 7 cumulative doses of atropine sulphate 1% eye ointment to achieve complete cycloplegia. Whether the same effect can be achieved with less potent cycloplegic agents (viz. cyclopentolate, homatropine or tropicamide) or lesser application of atropine is unknown. Based on the previous literature and well
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