An Overview on Refractive Accommodative Esotropia

Abstract

Accommodative esotropia (ET) is the most common form of childhood ET. The prevalence of accommodative ET has been estimated to be 1%–2% in the Western population. The convergent misalignment of visual axes has been attributed to hyperopia associated with an abnormal fusional divergence. Accommodative ET initially presents as intermittent esodeviation between 1½ and 4 years of age. It has a favorable prognosis if appropriate treatment is initiated early. Optical correction of hypermetropia is usually successful in reestablishing ocular alignment. There has always been a concern regarding striking a balance between achieving bifoveal fixation and avoiding interference with emmetropization by prescribing full hypermetropic refractive correction when treating accommodative ET in young children. The management of accommodative ET includes (1) identifying risk factors for the development of accommodative ET, (2) providing optimal refractive correction without interfering with the process of emmetropization, and (3) weaning of glasses when possible.