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Updated: Aug 14, 2025

Using an Automated Hirschberg Test App to Evaluate Ocular Alignment
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Interventions for infantile esotropia.

Lauren Mehner1, Sueko M Ng1, Jasleen Singh2

  • 1Department of Ophthalmology, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.

The Cochrane Database of Systematic Reviews
|January 16, 2023
PubMed
Summary
This summary is machine-generated.

Surgical intervention for infantile esotropia (IE) may offer better outcomes than botulinum toxin injections, though evidence is very uncertain. Current research also shows no significant difference between bilateral and unilateral surgeries for IE treatment. Further high-quality trials are needed.

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Area of Science:

  • Ophthalmology
  • Pediatric Ophthalmology
  • Strabismus Management

Background:

  • Infantile esotropia (IE) is a common inward eye deviation in infants.
  • Optimal treatment strategies and timing for IE remain unclear.
  • This review addresses the effectiveness and timing of interventions for IE.

Purpose of the Study:

  • To evaluate surgical and non-surgical treatments for IE.
  • To determine the optimal timing for IE interventions.
  • To improve ocular alignment and binocular single vision in children with IE.

Main Methods:

  • Systematic search of CENTRAL, MEDLINE, Embase, and trial registers up to November 2021.
  • Inclusion of randomized and quasi-randomized trials comparing interventions for IE.
  • GRADE classification used to assess the certainty of evidence for key outcomes.

Main Results:

  • Surgery may improve treatment success compared to botulinum toxin, but evidence is very uncertain (RR 1.88, very low certainty).
  • No significant difference in over-correction or need for additional interventions between surgery and botulinum toxin.
  • No important difference in outcomes between bilateral and unilateral recession surgeries (very low certainty).

Conclusions:

  • Medial rectus recession might offer better treatment success than botulinum toxin for IE, but evidence is very limited.
  • Current evidence does not support a difference between bilateral and unilateral surgical approaches.
  • High-quality trials are essential to resolve uncertainties regarding IE treatment type, non-surgical options, and intervention timing.