ICO International Clinical Guidelines:
Esotropia (Initial and Follow-up Evaluation)
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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, genetic diseases. [A:III]
Initial Physical Exam (Key elements)
- Visual acuity [A:III]
- Ocular alignment (at distance and near) and motility [A:III]
- Extraocular muscle function [A:III]
- Detection of nystagmus [A:III]
- Sensory testing [A:III]
- Cycloplegic retinoscopy/refraction [A:III]
- Fundoscopic examination [A:III]
Care Management
- Consider all forms of esotropia for treatment and re-establish ocular alignment promptly [A:III]
- Prescribe corrective lenses for any clinically significant refractive error [A:I]
- If optical correction does not align the eyes, then surgical correction is indicated [A:III]
- Start amblyopia treatment before surgery to reduce angle of strabismus or increase likelihood of binocularity [A:III]
Follow-up Evaluation
- Periodic evaluations necessary until visual maturity reached [A:II]
- Hyperopia should be assessed every 1 to 2 years [A:III]
- More frequent cycloplegic examinations are indicated in cases with changes in acuity, amblyopia, or unstable alignment [A:III]
- If the examination has been stable, follow-up evaluations are appropriate every 1 to 2 years during teenage years [A:I]
Esotropia Follow-up Evaluation Intervals [A:III]
| Age (years) | Interval (months) |
|---|---|
| 0-1 | 3-6 |
| 1-5 | 6-12 |
| 5 | 12-24 |
Patient Education
- Discuss findings with the patient when appropriate and/or parents/caregivers to enhance understanding of disorder and to recruit them in a collaborative approach to therapy. [A:III]
- Formulate treatment plans in consultation with the patient and/or family/caregivers. [A:III]
* Adapted from the American Academy of Ophthalmology Summary Benchmarks, November 2008 (www.aao.org)
(Download this Guideline as a PDF file - 129 KB)
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