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2007 Series -  June 26, 2007 Lecture 27 of 52  NEXT»

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At near fixation on an accommodative target and picture, the ET measures 45 PD. At distance fixation, the child demonstrates a 5 PD XT.

This 3-year-old girl was examined by another doctor who prescribed glasses as follows:  OD + 3.25 + 1.00 x 90 and OS +2.75 + 1.00 x 100.  She wears her glasses well, but the family is worried because her eyes turn out a little in the distance and turn in a great deal at near.  Without glasses she measures 15 PD esotropia at the distance and 55 PD esotropia at near.  At this examination the girl does not demonstrate fusion, but this is difficult to measure in the distance.  Cycloplegic refraction is as she is wearing.  Versions and ductions are normal.  The media are clear and the posterior pole is normal.  The child does not complain of diplopia.  On careful questioning, the family states that the eyes began to cross about six months ago.  The girl is otherwise healthy and there is no family history of strabismus.

1.  The most likely diagnosis is:   

a. refractive/accommodative esotropia
b. refractive esotropia
c. monovision
d.  accommodative spasm
e. none of the above

2.  The most likely cause of this strabismus is:  

a. inattention
b. hyperactivity
c. poor glasses fitting with de-centered lenses
d.  high AC/A
e. none of the above

3.  An appropriate treatment would be: 
a. discontinue glasses for a month and start over
b. leave the girl as she is; there is not much more that can be done
c. reduce the plus in the distance until the eyes are aligned and prescribe a bifocal add strong enough to align the eyes at near
d.  do a faden of both medial rectus muscles
e. none of the above

For answers to the above, click here on or after July 3, 2007.


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