“Tying the Knot”—Surgical Choices in Esotropia: When? How Much? How Many?

Abstract

This esotropia symposium has thus far explored the assessment and nonsurgical treatment of convergent strabismus. This paper will deal with surgical choices in esotropia. When is it appropriate to operate for esotropia? How many muscles should be operated and using what dosage? Although the exact effect of ocular muscle surgery for esotropia can be difficult to predict, surgical success can be maximized by careful evaluation, precise and consistent surgical technique, and judgement based on experience. Analysis of outcomes and the development of “fudge factors” will greatly enhance the surgeon's ability to promote normal binocular vision, improve or relieve symptoms, and restore normal appearance.