NPOG 2009 Abstract template

Foredragsholder / Presenter

Navn / Name : Anna Majander

Institusjon/Institution: Helsinki University Eye Hospital

Avdeling / Department :

Gate / Street: Haartmaninkatu 4

Post nr. / zip code: 00029 HUS

Land / Country: Finland

ABSTRACT

Treatment of Late-onset Normosensoric Esotropia in Children

Case Report of Five Patients

Introduction Acquired esotropia in children is an heterogenous group of comitant and incomitant strabismus. The late-onset normosensoric esotropia is a symptomatic comitant form of acquired esotropia, which appears in children aged 2 y or more and normally developed binocularity. Motor fusion suddenly deteriorates, in some cases after febrile infection, leading to esotropia and diplopia. Children do not commonly complain about diplopia, but close the deviating eye. The neurologic status is normal.

Patients Five children, four girls and one boy, aged 2y4m to 6y (mean 4y) at the time of diagnosis. Four patients underwent brain MRI and three patients neurologic evaluation. None of them had CNS findings responsible for esotropia. Three patients had hyperopia of +3 diopters, or more, and partially refractive component in their esotropia.

Treatment Strabismus surgery was performed within 5 – 9 months (mean 6.5) after diagnosis. Preoperatively the binocularity was preserved with compensating prisms in all the patients, but only two patients had normal stereopsis. Surgery was performed according to full cover test angles, mean +30 prismdiopters in distance and +34 in near. A combined medial rectus recession and lateral rectus resection was performed.

Results In two patients esotropia re-decompensated with large angle after the first operation and re-operation was required. The other three received alignment with one operation. All the patients received binocularity and four of them normal stereopsis postoperatively. All the patients were asymptomatic despite of residual esophoria between 2 to 10 prismdiopters in the last follow-up.

Conclusions It is important to recognise the condition and align the optic axes immediately with compensating prisms and surgery. The surgery should be performed according to full cover test angles. Despite of that, re-decompensation can occur requiring second surgery. With early treatment stereopsis and normal binocularity can be preserved.