Related Experiment Video
Updated: Aug 17, 2026
Surgical Correction for Pediatric Epiblepharon and Trichiasis
Published on: July 8, 2025
Three-muscle surgery for infantile esotropia in children younger than age 2 years
Olga V Minkoff1, Sean P Donahue
1Tennessee Lions Eye Center, Vanderbilt Children's Hospital, Nashville, Tennessee, USA.
Insights
Three-muscle surgery for infantile esotropia in infants resulted in a high rate of overcorrection and need for further surgery. This approach may be inappropriate for large-angle cases in this age group.
Area of Science:
- Ophthalmology
- Pediatric Surgery
Background:
- Infantile esotropia is a common condition requiring surgical intervention.
- Large-angle infantile esotropia presents unique challenges in surgical management.
Purpose of the Study:
- To evaluate the long-term outcomes of three-muscle surgery in infants with large-angle infantile esotropia.
Main Methods:
- Retrospective review of surgical records for 10 infants with esotropia >= 55 prism diopters (PD).
- Analysis of outcomes including alignment, over/undercorrection, and need for reoperation.
Main Results:
- Only 30% of patients achieved satisfactory horizontal alignment after a single three-muscle surgery.
- A significant overcorrection rate of 60% was observed, necessitating additional surgical procedures.
- Undercorrection occurred in 10% of patients.
Conclusions:
- Three-muscle surgery may lead to high rates of overcorrection in infants with large-angle infantile esotropia.
- This surgical approach might be less suitable for infants compared to older children or adults.
- Further prospective studies are recommended to clarify optimal surgical strategies.
Purpose:
To review the long-term outcome of infants undergoing three-muscle surgery for infantile esotropia.
Patients And Methods:
Surgical records of 10 patients with esotropia > or = 55 prism diopters (PD) who underwent three-muscle surgery for large-angle infantile esotropia were reviewed. Outcome measures included over- or undercorrection, need for additional surgery, and amount of deviation at last follow-up.
Results:
Mean age at initial surgery was 13 months. Mean preoperative deviation was 62.5 PD of esotropia. A single surgery was associated with satisfactory horizontal alignment in only three (30%) patients at last follow-up (mean, 37.1 months; range, 8-70 months). Esotropia was undercorrected in one (10%) and overcorrected in six (60%) patients, all of whom required additional surgery. One patient with satisfactory horizontal alignment required an additional procedure to correct a right hypertropia causing a left face turn.
Conclusions:
In contrast to older children and adults, three-muscle surgery may be inappropriate for infants with large-angle esotropia due to a large overcorrection rate. This controversy may benefit from a prospective study.
Related Concept Videos
01:20Muscles of the Eye
Extraocular Muscles
The six extraocular muscles surround the eyeball and control its movements. They are responsible for a wide range of eye motions, including looking up, down, left, right, and rotating...
01:17Accessory Structures of the Eye