Ocular alignment under general anesthesia in congenital esotropia

Ocular alignment is usually more divergent in strabismus patients under general anesthesia than in the awake state. Although clinical and anesthetized alignments have been reported to be correlated through the equation A = 0.8P + 30, significant differences in the amount of divergence under anesthesia have been reported between esotropes and exotropes. We found differences in response to general anesthesia in a group of 83 congenital esotropes. The averaged anesthetized alignment pertained to the whole group of 6.2 prism diopters of esotropia, which correlated poorly with the preoperative deviation. Mean anesthetized alignments were similar for any amount of preoperative deviation. Recommendations of intraoperative adjustment of surgery based on the anesthetized position should, in our opinion, be reconsidered and recalculated when treating congenital esotropes. A prediction of surgical results following these recommendations suggested an increase of the undercorrection rate, probably linked to an incorrect identification of normal and anomalous cases to the Apt-Romano test.