Constant Esotropia with Anomalous Correspondence
Sharpens retinal image and/or alters vergence of eyes.
Fully correct anisometropia and/or astigmatism.
Avoid "fogging" eso-deviations for distance; can Rx more plus later when latency is uncovered.
Cycloplegic examination helpful for eso-deviations with hyperopia.
Can use base-in prism to make the eyes appear optically more aligned in esotropia with ARC.
Effective for suppression and amblyopia.
Constant esotropes with no fusion potential should have constant occlusion until amblyopia is maximally reduced after which it can be gradually reduced.
Complete occlusion better than graded.
Regimen should be specifically prescribed and monitored; for infants and young children, occlude preferred eye 1 day/week/year of age.
Six to 8 weeks is minimum period for initial occlusion and for continued occlusion beyond last measured improvement.
Two hrs./day is minimum time for effective occlusion.
Treat most types of unsteady and/or eccentric fixation in conjunction with acuity improvement program.
Stimulate fovea under monocular conditions to improve resolution.
Gradually decrease monocular target size and element separation.
Large (greater than 2 to 4 p.d.) and steady E.F. should ordinarily be treated first as oculomotor problem; stimulate foveal fixation (e.g., entoptic imagery and auditory feedback) combined with pursuit and saccadic training.
Reinforce therapy with kinesthetic, auditory, and visual feedback.
When changing mechanical advantage of oculo-rotary muscles by surgery, post- surgical comitance is desired goal.
Smaller surgical changes on several muscles tend to give better comitance.
Second operation may be necessary to correct vertical deviations.
Early surgery may be advantageous for esotropia.
Pre- as well as post-surgical optical correction and orthoptics for amblyopia can be helpful.
Surgery may be required for large angles (i.e. more than 20 p.d. eso).