Fully Accomodative ET Characteristics

Summary

This video explains the characteristics of fully accommodative esotropia (EOT), a condition where a child’s eyes turn inward due to excessive accommodation needed to overcome moderate hypermetropia (farsightedness). It covers the condition’s etiology, clinical presentation, and management strategies, including refractive correction with glasses or contact lenses. The video also highlights the importance of a cover test for diagnosis and discusses potential outcomes such as amblyopia and the restoration of binocular vision. The content is aimed at understanding how excessive accommodation can lead to esotropia and how proper correction can improve visual function.

Takeaways

• 😀 Fully accommodative esotropia (EOT) is a type of intermittent esotropia caused by uncorrected hypermetropia, often referred to as refractive accommodative esotropia.
• 😀 The condition is characterized by a moderate degree of hypermetropia, which causes excessive accommodation, leading to accommodative convergence and potentially resulting in esotropia.
• 😀 In children with moderate hypermetropia (around +3 or +4 diopters), excessive accommodation to compensate for blurred vision can cause esotropia, while others may only develop an esophoria.
• 😀 High accommodative convergence-accommodation (ACA) ratio can lead to a convergence excess pattern, which may cause a different classification of strabismus.
• 😀 Patients with fully accommodative EOT generally have normal ACA ratios, and their deviation is stable across near and distance testing.
• 😀 The condition typically develops between 18 months and 4 years of age, when children engage in more close work like coloring, increasing their need for accommodation.
• 😀 Diagnosis involves a cover test with an accommodative target to assess how the esotropia changes with and without corrective glasses.
• 😀 Without glasses, the patient will have manifest esotropia, but with glasses correcting hypermetropia, the eyes should align properly, and they may exhibit an esophoria or orthophoria.
• 😀 Amblyopia may develop if hypermetropia is uncorrected for long periods, but it is usually mild and treatable.
• 😀 Binocular functions are often suppressed in the manifest phase, but when glasses are worn, the patient should regain normal stereopsis and fusion range.
• 😀 Contact lenses can be an alternative to glasses, providing similar visual benefits without the need for excessive accommodation, and improving cosmesis.

Q & A

What is fully accommodative esotropia (EOT)?

Fully accommodative esotropia (also called refractive accommodative esotropia) is a condition where a child experiences inward eye deviation (esotropia) that can be fully corrected with glasses or other refractive correction. It is caused by excessive accommodation due to hypermetropia (farsightedness).

What is the primary cause of fully accommodative esotropia?

The primary cause is moderate hypermetropia (farsightedness), which leads the child to excessively accommodate (focus) to compensate for the blur caused by their refractive error. This excessive accommodation leads to **accommodative convergence** and results in esotropia.

At what age does fully accommodative esotropia typically develop?

Fully accommodative esotropia generally develops between 18 months and 4 years of age, when children start engaging in more close-up work, like coloring and reading, which requires more accommodation.

How can fully accommodative esotropia be diagnosed?

The condition can be diagnosed through a cover test with an accommodative target (e.g., N5 print). The test should be performed with and without corrective lenses to assess how the child’s eyes respond when their accommodation is engaged.

How does a cover test help in diagnosing fully accommodative esotropia?

A cover test helps in diagnosing by revealing the presence of esotropia when the child is not wearing glasses, which resolves when corrective lenses are applied. The deviation may vary depending on the level of accommodation used by the child.

What role do glasses play in managing fully accommodative esotropia?

Glasses correct the hypermetropia, reducing the need for excessive accommodation. This eliminates the inward eye deviation (esotropia) and restores normal binocular function, improving vision and preventing the development of amblyopia (lazy eye).

Can contact lenses be used to treat fully accommodative esotropia?

Yes, contact lenses can also be used to correct hypermetropia and manage fully accommodative esotropia. They provide the same benefits as glasses, including improving vision and cosmesis, especially as the child grows older.

What is the role of binocular vision in fully accommodative esotropia?

Binocular vision refers to the ability of both eyes to work together to produce depth perception (stereopsis). With corrective lenses, children usually regain normal binocular function, including stereopsis. Without glasses, they may suppress or experience diplopia (double vision).

What are the risks if fully accommodative esotropia is left untreated?

If left untreated, the child may develop amblyopia (lazy eye) due to the uncorrected hypermetropia and the lack of proper visual input. However, early detection and treatment with glasses or contacts typically prevent this.

What is the significance of the ACA ratio in fully accommodative esotropia?

The ACA (accommodative convergence to accommodation) ratio helps in understanding how much convergence occurs when a person accommodates. In fully accommodative esotropia, the ACA ratio is generally normal. A high ACA ratio can indicate convergence excess, while a low ACA ratio can help prevent significant esotropia.

Why is the cover test performed with an accommodative target (like N5 print)?

The cover test with an accommodative target is crucial because it helps assess how much accommodation the child is using. The deviation may change depending on the child’s accommodation level, so controlling accommodation by using detailed targets helps get an accurate diagnosis of the deviation.