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Progression of intermittent, small-angle, and variable esotropia in infancy.

Authors:
Valeria L N Fu David R Stager Eileen E Birch

Invest Ophthalmol Vis Sci 2007 Feb;48(2):661-4

Pediatric Eye Research Laboratory, Retina Foundation of the Southwest, Dallas, Texas 75231, USA.

Purpose: Esotropia (ET) in infancy may initially manifest as a small-angle, variable-angle, or intermittent deviation. Some patients experience spontaneous resolution and become orthophoric. Others progress to constant large-angle ET and require surgery. The authors examined factors that may be associated with risk for progression to constant large-angle ET.

Methods: Seventy-seven infants who initially presented with intermittent, small (<20 prism diopter [pd]) or variable-angle ET at 2 to 12 months of age were followed up until the ET was resolved, the infants had surgery, or the parents or guardians refused surgery. All infants with refractive correction >/=+3.50 D were treated initially with glasses. Four risk factors were examined: prescription of occlusion therapy, initial visit before 6 months of age, presence of amblyopia, and abnormal stereoacuity.

Results: All 12 infants with small or variable angles progressed to constant large-angle ET and surgery. ET resolved spontaneously in 44.6% (29/65) infants in whom it was intermittent. Infants with intermittent ET who received patches as initial treatment and who had abnormal stereoacuity had 3.4x (95% confidence interval [CI], 1.83-6.29) and 3.4x (95% CI, 1.66-6.78) higher risk for progression to constant large-angle ET, respectively. Neither age at initial visit nor amblyopia presented risk for progression.

Conclusions: Abnormal stereoacuity and occlusion therapy pose significant risks for progression from intermittent to constant large-angle ET. Intermittent ET that develops during the first year of life has a high likelihood of spontaneous resolution, whereas constant small-angle or variable-angle ET seldom resolves.

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http://dx.doi.org/10.1167/iovs.06-0717DOI Listing
February 2007

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