Early-onset accommodative esotropia

Purpose: To determine the frequency of accommodative esotropia with onset b y 6 months of age; to determine if the presence or absence of characteristi cs usually associated with infantile esotropia can help in the diagnosis; a nd to determine if antiaccommodative therapy is adequate treatment for the esotropia. Methods: The charts of 100 patients with infantile esotropia, seen over a 2 -year period (September 1995 to September 1997), were reviewed. We identifi ed those with at least 2.25 diopters (D) of hyperopia and determined the pr esence of large angle esotropia (>30 to 40 prism diopters [Delta]), amblyop ia, inferior oblique overaction, dissociated vertical deviation, latent nys tagmus, and cross-fixation. The success of antiaccommodative therapy, ii at tempted, was also evaluated. Results: Of 100 patients with infantile esotropia, 15 (15%) were found to h ave at least +2.25 D. This represented 8% of all patients with accommodativ e esotropia seen over the same time period. The average age at initial exam ination was 21 months, although the reported age of onset in all cases was 6 months or less. Two had surgery before presenting to our institute. Eleve n of 13 (84%) had 40 Delta or less. Six (40%) of the 15 had amblyopia, 5 (3 3%) had inferior oblique overaction, 3 (20%) had dissociated vertical devia tion, 1 (7%) had latent nystagmus, and 4 (27%) had cross-fixation. Of the 1 3, 7 were given glasses initially, with 3 being fully corrected. Six were n ot given glasses, all had surgery, and all were given glasses postoperative ly for a residual esotropia. Conclusion: Fifteen percent of infantile esotropia patients and 8% of accom modative esotropia patients have infantile accommodative esotropia. other c haracteristics of infantile esotropia may be present, but are less frequent , and at least 40% are fully corrected with spectacles indicating that when the hyperopia is 2.25 D or greater, antiaccommodative therapy should be in stituted before surgery.