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Squint Free Papers
dilated pupils, we assumed that 7 applications of atropine were enough to
produce complete cycloplegia. Ideally, a clinician should routinely perform
dynamic retinoscopy to confirm complete cycloplegia for every patient
especially if less potent cycloplegic agent is used. In this study, atropine was
not associated with any severe systemic side effects.
In one patient who had esotropia with nonaccommodative convergence
excess, the esotropia persisted under cycloplegia. The esotropia persisted for
smaller as well as larger size of the accommodative targets and on the torch
light evaluation. It was evident that atropinic cycloplegia was unable to abolish
excessive convergence in that patient. It was less likely to be due to incomplete
cycloplegia because, in this patient, we had confirmed complete cycloplegia
using dynamic retinoscopy and dynamic autorefractometry. 6
In conclusion, measurement of ocular deviation under cycloplegia can
be helpful to differentiate the accommodative component from the nonaccommodative
component in patients with esotropia and hyperopia. In this
study we could reliably differentiate the patients with esotropia and hyperopia
who would achieve orthotropia by full refractive correction alone (59.1%). An
ophthalmologist can inform the parents accordingly. Of the remaining 40.9%,
how many would be controlled by the fusional divergence or will need prisms
or will need a squint surgery can be known from the follow up. The effect of
other cycloplegic agents and the utility of measurement of ocular deviation
under cycloplegia in accommodative esotropes pursuing a refractive surgery
need further studies.
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accommodative component of esotropia. In: Lenerstrand G, editor: Update on
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