The “Accomplice”—Accommodative Esotropia

Abstract

Accommodative esotropia can be divided into three categories: refractive, abnormal AC:A ratio, and a combination group. Though small in number, patients with esotropia associated with myopia, or with a low AC:A ratio should not be overlooked.

Successful nonsurgical treatment of accommodative esotropia depends upon accurate determination and appropriate correction of the refractive error, and also careful assessment of the AC:A ratio. Nonsurgical treatment may be as simple as glasses alone to provide good alignment and fusion, or may include additional bifocal lenses, miotics, or orthoptic exercises. Nonsurgical treatment is considered successful if fusion is achieved. Unfortunately, 13% of patients have been reported to deteriorate, whereby the esotropia increases and fusion is lost after a period of successful nonsurgical treatment. Such patients require prompt prism adaptation and surgery to restore the previous state of good alignment and fusion.

• Accommodative esotropia
• refractive error
• High AC/A ratio
• esotropia