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Unusual presentations of accommodative esotropia.

Z F Pollard¹, M F Greenberg

¹Department of Ophthalmology, Scottish Rite Children's Medical Center, Atlanta, USA.

Transactions of the American Ophthalmological Society

|February 24, 2001

Summary

Accommodative esotropia can present unusually in infants and older children, triggered by factors like trauma or diabetic ketoacidosis. Early detection and refractive correction are key to managing this condition effectively.

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Area of Science:

Ophthalmology
Pediatric Ophthalmology

Background:

Accommodative esotropia typically manifests in infants and toddlers (6 months to 2 years).
This study investigates atypical presentations outside the usual age range and those with specific triggers.

Observation:

Reviewed 17 patients with unusual accommodative esotropia over 25 years.
Identified cases in infants (<6 months) with high myopia or significant hyperopia.
Found trauma as a trigger in older children (5-14 years) and diabetic ketoacidosis in a teenager.

Findings:

All 17 patients achieved initial control of esotropia with corrective lenses (glasses).
Some trauma-related cases required bifocals for near deviation control.
Surgery was necessary for only two patients with early-onset esotropia (<6 months).

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Implications:

Accommodative esotropia can occur earlier than 6 months and later than 2 years.
Trauma and diabetic ketoacidosis are potential precipitating factors in diverse age groups.
Refractive correction with glasses is highly effective, often avoiding surgical intervention.