The Clinical Course of Esotropia Associated with Hypermetropia after Initial Wearing of Glasses

ABSTRACT

PURPOSE: To investigate clinical course of esotropia associated with hyperopia after initial wearing of the glasses. METHODS: Patients with onset earlier than 6 months of age, or with vertical strabismus greater than 3delta were excluded. The time intervals between initial wearing of the glasses and decrease of esophoria (tropia) to 8delta or less, minimun amount of hypermetropic correction to straighten the eyes and clinical course after initial prescription of hyperopic spectacles were analyzed. RESULTS: There were 21 boys and 23 girls. The average onset of esotropia was 35.4 months of age, and the timing of initial wearing of the glasses was 44.4 months. The average deviation at near without correction was 29.6 delta. Average refractive error was +4.25 diopters (D) OD and +4.16D OS, with the minimum of +1.63D OD and +1.38D OS in one patient. Among 44 patients, 22 showed esophoria (tropia) of 8 delta or less within two weeks, and five between 2 and 7 weeks. Three were corrected after wearing new glasses by repeat cycloplegic refraction with atropine (2 patients), or with cyclopentolate (1 patients). Esotropia was resolved after occlusion therapy for amblyopia in one patient. Eleven were partially accommodative esotropia. Among 33 refractive accommodative esotropia, two deteriorated to partially accommodative esotropia, one to high AC/A ratio esotropia, and one to exotropia. CONCLUSIONS: Hyperopia as small as +1.50D should be corrected. If significant esotropia remained after seven weeks of initial wearing of hyperopic glasses, it would be prudent to perform cycloplegic refraction again with atropine. Six percent of refractive accommodative esotropia decompensated to partially accommodative esotropia.