Infantile Esotropia

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Infantile Esotropia

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By: drgorav (88 month(s) ago)

nice presentation

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Infantile Esotropia:

Dr. Huseynova Tukezban Chairman of ADMO YO. Baku, Azerbaijan tukezban@gmail.com www.admo.org.az. Infantile Esotropia

Definition:

Definition Infantile Esotropia (IE) is a large-angle esotropia that is present before 6 months of age.

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Etiology

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The Worth theory states that the esotropia is caused by a congenital absence of cortical fusion potential. The Chavasee theory contends that the congenital esotropia represents a sensory and motor abnormalities.

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Nazal ODC Temporal ODC cortex LGN + + + + Signal flow diagram ODC – Ocular Dominance Columns LGN – Lateral Geniculate Nucleus

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Functional Deficits in Infantile Esotropia Fusion Deficits Absence of motor fusion Lack of stereopsis Alterneting monocular supression Subnormal binocular VEPR Motion Deficits Asymmetric monocular tracking Asymmetric monocular motion Asymmetric motion perception

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What causes esotropia When the sensory and motor functions are sufficiently mature, they interact, through the meditation of an inborn cortical fusion faculty that has both a motor fusion and a sensory fusion component. This is the ‘keystone’ of the ‘arch’ that has a sensory (S) ‘arm’ and a motor (M) ‘arm.’ S M A. Before 2 months of age, the motor and sensory systems are immature .

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What causes esotropia B. Completed ‘arch’ between 2 and 4 months.

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What causes esotropia The completed “arch” with “crowned” stereopsis.

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What causes esotropia Congenital Esotropia The absence of the “keystone” of sensorimotor fusion causes a collapse of the forming arch of normal binocular vision resulting here in esotropia.

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Clinical Investigation

The minimum required findings for diagnosis are::

The minimum required findings for diagnosis are: Esotropia – usually 40 to 50 D (with a range of 10 to 90 prism dioptrers ). 2. Normal neurologic status (except for strabismus) Refractive error expected for age (usually low to moderate hyperopia ), correction of which does not eliminate esotropia . Asymmetric optokinetic nystagmus characterized by robust temporal to nasal response and erratic nasal to temporal response.

Other common clinical findings (not essential):

Other common clinical findings (not essential) Manifest nystagmus – is present at all times. Nystagmus most commonly causes the eyes to look involuntarily from side to side in a rapid.

Other common clinical findings (not essential):

Other common clinical findings (not essential) Latent nystagmus – occurs when one eye is covered

Other common clinical findings (not essential):

Other common clinical findings (not essential) Oblique muscle dysfunction * Inferior Oblique Overaction

Other common clinical findings (not essential):

Other common clinical findings (not essential) Dissociated strabismus * Dissociated Vertical Deviation (DVD)

Other common clinical findings (not essential):

Other common clinical findings (not essential) Dissociated strabismus * Dissociated Horizontal Deviation (DHD)

Other common clinical findings (not essential):

Other common clinical findings (not essential) Dissociated strabismus - Dissociated hypertropia - Dissociated hyperphoria - Dissociated horizontal deviation (exo) Dissociated Strabismus Complex

Other common clinical findings (not essential):

Other common clinical findings (not essential) Torticollis - literally means "twisted neck". The name is derived from the Latin terms torta meaning twisted and collum meaning neck.  It is also called ‘wry neck’.

Types of Infantile Esotropia:

Types of Infantile Esotropia Pseudo – Esotropia Infantile Accommodative Esotropia Ciancia’s syndrome Cross Fixation Congenital fibrosis syndrome (or strabismus fixus) Nystagmus Blockage Syndrome

Types of Infantile Esotropia:

Types of Infantile Esotropia Pseudo – Esotropia : occurs in infants who have a wide nasal bridge with prominent epicanthal folds.

Types of Infantile Esotropia:

Types of Infantile Esotropia Infantile Accommodative Esotropia : Esotropia in babies as young as 2 months which is correcting by hyperopic spectacles .

Types of Infantile Esotropia:

Types of Infantile Esotropia Ciancia’s Syndrome: a large-angle congenital esotropia with cross-fixation, and both eyes appear to be “stuck” in toward the nose. * Ciancia’s syndrome = Cross fixated eyes + Nystagmus (in abduction)

Types of Infantile Esotropia:

Types of Infantile Esotropia Cross-Fixation: with limited abduction and tight medial rectus muscles adopt a face turn to fixate with an eye in adduction.

Types of Infantile Esotropia:

Types of Infantile Esotropia Congenital Fibrosis Syndrome: is a congenital restrictive strabismus.

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Management

Medical Therapy:

Medical Therapy Infants with small angle Et<30 PD may be corrected with hypermetropic spectacle correction. Treating amblyopia if it’s determined.

Medical Therapy:

Medical Therapy If +3.00 sph or more hyperopia Prescribe full refractive error

Medical Therapy:

Medical Therapy If < +3.00 sph hyperopia Spontaneous alternation If one eye fixated Treat amblyopia until child alternates Surgery

Surgical therapy:

Surgical therapy Frank Costenbader Surgery between 12-18 m.o “Regain binocularity as early……as possible an……maintain.”

Surgical therapy:

Surgical therapy Marshal M. Parks Recommended lowering age to 6 m.o “…for light “fusion” or stereopsis”

Surgical therapy:

Surgical therapy The surgery could be done at 4 months.

Surgical therapy:

Surgical therapy Surgery consist of: Bimedial rectus recession Lateral rectus resection Medial rectus recession and lateral rectus resection of one eye Three-muscle prosedure ( bimedial rectus recession+resection of one lateral rectus In a very few cases a four-muscle surgery ( bilateral resection-recession)

Surgical therapy:

Surgical therapy Measurement from the limbus is based on more reliable landmark than the muscle insertion site can vary from 3.0 to 6.0 mm.

Surgical therapy:

Surgical therapy Ing and Helveston, favour a prescribed approach often involving multiple surgical episodes whereas others prefer to aim for full alignment of the eyes.

Surgycal therapy:

Surgycal therapy The best attainable result from treatment esotropia in my experience is subnormal binocular vision.

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Thank you

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