Up-shoot in adduction has no prognostic value for decompensation in refractive accommodative esotropia

To assess whether up-shoot (elevation) in adduction has any prognostic value for the functional outcome of binocular vision in fully refractive accommodative esotropia (RAET).

A retrospective study was performed on 58 patients initially diagnosed with RAET who were followed for at least 4 years.

Without glasses, up-shoot in adduction with or without a V pattern was detected in 22 of 51 patients who maintained normal binocular alignment during the whole follow-up and in 3 of 7 patients who lost normal binocular vision and showed a manifest esotropia despite glasses at any time of the follow-up. Up-shoot in adduction was still present through glasses only in 3 patients among these 25 cases. Two of these remained fully compensated with glasses during the considered period. The third case developed up-shoot in adduction after decompensation of a previously compensated strabismus.

Up-shoot in adduction is not a common sign in RAET. When present, it does not necessarily represent a negative prognostic sign for preservation of normal binocular vision through glasses in this condition. Up-shoot in adduction can develop after the loss of alignment in some decompensated patients. There is therefore no evidence in favour of a cause-effect relationship between up-shoot in adduction and loss of binocularity in RAET.