Question

Describe the clinical features and management protocols of infantile esotropia.

Hint:

Early surgical intervention is key to improving outcomes in infantile esotropia, particularly in terms of aligning the eyes and minimizing the risk of amblyopia.

Answer 1

Step 1: Clinical Features of Infantile Esotropia.
Infantile esotropia is a condition where one or both eyes turn inward (toward the nose) from birth or shortly after, often without any clear external cause. The clinical features include:
(1) Onset Before 6 Months of Age: Infantile esotropia typically presents within the first 6 months of life. It is characterized by a constant inward deviation of the eyes, which is usually not related to any external factors or associated conditions.
(2) Constant Strabismus: The esotropia is usually constant, and it may be present at all times or only in certain gaze directions.
(3) No Stereopsis or Depth Perception: Due to the misalignment of the eyes, children with infantile esotropia often lack binocular vision and, consequently, stereopsis (depth perception).
(4) Diplopia (Double Vision) in Older Children: In older children, the misalignment of the eyes may cause double vision, though this is less common in infants due to the brain's ability to suppress one image.
(5) History of Family Members with Strabismus: There is often a family history of strabismus, suggesting a genetic predisposition.
(6) Abnormal Head Posture: Some children may tilt or turn their heads to try to compensate for the misalignment of their eyes.
Step 2: Management Protocols for Infantile Esotropia.
The management of infantile esotropia involves both medical and surgical interventions, with the primary aim of aligning the eyes and preventing amblyopia. Key management strategies include:
(1) Non-Surgical Management (in some cases):
- Prescription Glasses: In cases where refractive errors contribute to esotropia, corrective lenses can help improve alignment. However, this approach is usually ineffective for pure infantile esotropia.
- Patching (for Amblyopi: If there is amblyopia (vision loss) in one eye due to the misalignment, patching the stronger eye may be used to strengthen the weaker eye.
- Prism Glasses: In some cases, prism glasses can help reduce the strain on the eyes and improve alignment, though they do not permanently correct the condition.
(2) Surgical Intervention:
- Strabismus Surgery: The mainstay of treatment for infantile esotropia is surgical alignment of the eyes. Surgery typically involves recession of the medial rectus muscles or resection of the lateral rectus muscles, depending on the severity of the condition. The goal is to restore proper ocular alignment and improve binocular vision.
- Timing of Surgery: Early surgery, ideally between 6 months and 2 years of age, is recommended for optimal outcomes. Surgery performed later may still be effective but may not result in perfect alignment or full recovery of binocular vision.
- Postoperative Care: After surgery, close follow-up is required to monitor for any recurrence of the esotropia and to manage any amblyopia.