- Acquired Esotropia: Acquired forms of esotropia occur at a later age than infantile esotropia. Usually, normal binocular vision has existed prior to the onset of the condition.
- Accommodative disease. This acquired strabismus is associated with the activation of accommodation. The esotropia is attributed partly or totally to either uncorrected hyperopic refractive error and/or a high accommodative convergence/accommodation (AC/A) ratio. Accommodative esotropia has a better understood mechanism and a more straightforward treatment or management than any other form of strabismus. It is reduced partly or entirely by correcting the hyperopic refractive error and/or prescribing a near addition.
- Nonaccommodative disease. An acquired strabismus that develops after 6 months of age, nonaccommodative esotropia is not associated with accommodative effort. Correcting any coexisting hyperopia and/or prescribing a near addition for children with nonaccommodative esotropia has minimal or no effect on the size of the disease.
- Acute disease. When a convergent strabismus develops suddenly without any apparent etiology in a school-aged or older patient with previously normal binocular vision, it is called acute disease. The sudden diplopia that usually occurs in acute disease may result from an underlying and potentially lifethreatening disease process, thus it requires immediate evaluation. Its onset can often be traced to a precise hour of a particular day.
- Mechanical disease. A convergent strabismus caused by a mechanical restriction or tightness of an extraocular muscle (e.g., fibrosis of muscle tissue, thyroid myopathy) or a physical obstruction (e.g., blowout fracture) of the extraocular muscles, is classified as a mechanical esotropia. Some patients with Duane syndrome have tightening of the medial and/or lateral recti muscles secondary to the primary underlying neurological miswiring and co-innervation. There is a limitation or absence of abduction, causing an increasing esotropia. The palpebral fissure narrows when the eye rotates inward (adduction). In addition, the patient may exhibit an upshoot or downshoot when the eye adducts.
- Sensory disease. A convergent strabismus resulting from visual deprivation or trauma in one eye that limits sensory fusion is classified as a sensory esotropia. It may result from any number of conditions that limit visual acuity in one eye (e.g., uncorrected anisometropia, unilateral cataract, corneal opacity, optic atrophy, macular disease). It occurs most frequently in persons under 5 years of age. Approximately 4 percent of those with esotropia have sensory disease.
- Consecutive disease. A convergent strabismus that occurs after surgical overcorrection of an exotropia, consecutive esotropia is frequently associated with other oculomotor anomalies (e.g., vertical or cyclotorsional deviations). It may result in amblyopia and loss of normal binocular vision in young children and diplopia in adults.
- Children who were initially responsive to glasses but later developed additional eye crossing (nonaccommodative esotropia) even with full hyperopic correction.
- Abnormalities in pregnancy and delivery.
- Arnold-Chiari malformation.
- Scleral ectasia in high myopia that can lead to a "downslip" of the lateral rectus muscle relative to the globe, giving this muscle a depressing effect at the cost of its physiological action.
- Myopic epikeratophakia.
- Neurologic abnormalities.
- Deficits of abduction.
- Sixth nerve palsy.
- Sixth nerve pseudo-palsy in children with esotropia with manifest-latent nystagmus.
- Unilateral or bilateral type 1 Duane syndrome.
- Heroin detoxification: Eye misalignments can occur during heroin use and heroin detoxification and can cause persisting diplopia (double vision).
- Occult sinus disease: Sinusitis supposedly leads to inflammation and secondary contracture in adjacent extraocular muscles.
- Visual acuity.
- Retinal exam.
- Neurological examination.
- Prism therapy.
- Amblyopia treatment.
- Extraocular muscle surgery.
- Treatment plans are formulated in consultation with the patient and parent/caregiver. The plans should be responsive to their expectations and preferences, including the family's/caregiver's perception of the existing alignment, which may differ from the ophthalmologist's, and what they hope to achieve with treatment. It is important that the family/caregiver and ophthalmologist agree on the goals of treatment before surgery is performed.
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