ICO International Clinical Guidelines:

Esotropia (Initial and Follow-up Evaluation)

(Download this Guideline as a PDF file - 129 KB)

On this page:

• Initial exam history
  
  
• Initial physical exam
  
  
• Care management
  
  
• Follow-up evaluation
  
  
• Patient Education

Initial Exam History (Key elements)

• Ocular symptoms and signs [A:III]
  
  
• Ocular history (date of onset and frequency of the deviation, presence or absence of diplopia) [A:III]
  
  
• Systemic history (review of prenatal, perinatal and postnatal medical factors) [A:III]
  
  
• Family history, including presence of strabismus, amblyopia, extraocular muscle surgery [A:III]

Initial Physical Exam (Key elements)

• Visual acuity [A:III]
  
  
• Ocular alignment (at distance and near) [A:III]
  
  
• Extraocular muscle function [A:III]
  
  
• Sensory parameters [A:III]
  
  
• Evaluation of the fundus, with attention to macular position [A:III]
  
  
• Cycloplegic refraction [A:III]

Care Management

• First prescribe corrective lenses for any clinically significant refractive error. [A:III]
  
  
• Consider all forms of esotropia for treatment and re-establish ocular alignment promptly. [A:III]
  
  
• If optical correction does not align the eyes, then surgical correction is recommended. [A:III]
  
  
• Treat significant amblyopia prior to esotropia surgery to increase likelihood of binocularity. [A:III]

Follow-up Evaluation

• Follow-up visits should include:
  
  
  • Tolerance and side effects of therapy [A:III]
    
    
  • Visual acuity and/or fixation pattern with correction of refractive error [A:III]
    
    
  • Deviation at distance and near fixation with correction of refractive error [A:III]
    
    
  • Observation of A or V patterns and/or oblique dysfunctions [A:III]
    
    
  • Status of binocular vision [A:III]
    
    
• Assess hyperopia using cycloplegia at least yearly, and 4 to 6 month intervals may be necessary [A:III]

Esotropia Follow-Up Evaluation Intervals [A:III]

Age (years)	Routine Interval Follow-up (months)*
0-1	1-3
1-5	3-6
5-10	6-12

*More frequent visits may be necessary if amblyopia is present or if there is a recent deterioration of alignment.

Patient Education

• Discuss findings with the patient when appropriate and/or parents/caregivers to enhance understanding of disorder and to recruit them in a team effort for therapy. [A:III]
  
  
• For adult patients, discuss advantages and disadvantages of various modes of treatment in developing a treatment plan. [A:III]
  
  
• Formulate treatment plans in consultation with the patient and/or family/caregivers, and the plans should be responsive to their expectations and preferences. [A:III]
  
  
• Discuss the potential psychological side effects with the patient and parent/caregiver as appropriate. [A:III]

* Adapted from the American Academy of Ophthalmology Summary Benchmarks, November 2006 (www.aao.org)

(Download this Guideline as a PDF file - 129 KB)

Next: Eye Disease in Leprosy (Initial evaluation and management)

Also see:

• International Clinical Guidelines (Preface)
  
  
• Introduction to the Guidelines
  
  
• List of Guidelines