Surgery for congenital esotropia

The diagnosis of esotropia in an infant is not generally a difficult one for a skilled ophthalmologist to confirm. Uncovering all the subtleties of the disease presents the greater challenge and taxes the skills involved in examining infants. The numerous treatment regimens available leave the surgeon who does this operation only occasionally in doubt as to when it is best to operate and by what method. The safest guidelines for the ophthalmologist are (1) to be sure of his diagnosis and all of its ramifications and (2) to operate on these patients by the method he feels will best totally correct both the horizontal and vertical defects in one operation. It is also known, however, that not all of these infants will be corrected by this single procedure and that additional surgery, both early and delayed, will be necessary. Similarly, amblyopia and accommodative esotropias will need to be treated in a significant segment of these patients. The stability of the final result depends upon the success of the treatment in all parameters. The results obtained are far from ideal. Some patients achieve the optimum with good and equal acuity in each eye, straight eyes, peripheral fusion, fusional amplitudes, and reduced stereopsis. Other patients will have reduced visual acuity secondary to amblyopia; deficient or no binocular cooperation; and larger eso-angles or even consecutive exo-angles - both of which will require further surgery. Congenital esotropia is a fascinating entity that requires more research before its etiology and pathogenesis will finally be understood. Only then will therapy produce a satisfactory and lasting result.