Presentation
The objective of the present study is to describe surgical results in congenital esotropia cases treated at the Ramon Pando Ferrer Ophthalmology Institute in Havana between January 2008 and May 2009. [mediccreview.org]
The term "congenital esotropia" has been used synonymously but the condition is rarely present at birth. The angle of deviation is constant and large ( 30 PD). [eyewiki.aao.org]
Entire Body System
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Surgical Procedure
METHODS: Review of the records of 44 patients (24 girls and 20 boys) with IENA seen between 1979 and 1998 who had undergone at least one horizontal surgical procedure. [ncbi.nlm.nih.gov]
Musculoskeletal
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Torticollis
[…] educational system.[16] The ICO is Cuba’s national ophthalmology reference center.[17] The ICO Pediatric and Strabismus Service receives patients referred from Havana and across the country for treatment intended to achieve ocular alignment, correct torticollis [mediccreview.org]
Eyes
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Esotropia
In congenital esotropia, patients may alternate fixation or show a fixation preference for one eye. [mediccreview.org]
BACKGROUND: In a previous study we investigated the advantages and drawbacks of early and delayed injection of botulinum toxin as primary treatment of infantile esotropia with nystagmus in abduction (IENA). [ncbi.nlm.nih.gov]
Infantile esotropia is esotropia that occurs during the first 6 months of life in an otherwise neurologically normal child. The term "congenital esotropia" has been used synonymously but the condition is rarely present at birth. [eyewiki.aao.org]
Genetic Inheritance in Non-Syndromic Infantile Esotropia. Biomed J Sci Tech R10.1136/bjophthalmol-2016-308769es [Internet]. 2018 Feb 1 [cited 2018 Nov 30];2(2). Available from: . Graziano RM, Leone CR. [revistas.ustabuca.edu.co]
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Strabismus
A strong fixation preference indicates significant amblyopia and should be treated by patching the dominant eye before strabismus surgery, as done at ICO. [mediccreview.org]
There can be a hereditary component with other family members having history of strabismus. [eyewiki.aao.org]
Brain Mapping Alterations in Strabismus. In: Diane E. Spinelle. Brain Mapping Alterations. New York: Nova Science Pub Inc; 2011:197-249. Engle EC. Genetic basis of congenital strabismus. Arch Ophtalmol. 2007;125(2):189-95. Gallegos-Duarte M. [revistas.ustabuca.edu.co]
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Diplopia
Other less common complications include perforation of the sclera, lost or slipped muscles, infection, anterior segment ischemia, postoperative diplopia, conjunctival granulomas and cysts. [eyewiki.aao.org]
Psychiatrical
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Suggestibility
While authors still disagree on optimal age for surgery, Prieto Díaz and others suggest that the earlier ocular alignment is achieved, the better the functional result attained.[12] He studied 171 surgically-aligned cases aged 4 years. [mediccreview.org]
Worth[1] theory suggests that there is an irreparable congenital defect in the infant's visual system and that surgery can be carried out at leisure mostly for cosmetic purposes. [eyewiki.aao.org]
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Impulsivity
The neural impulse favors extorsion over intorsion, leading to progressively increased tone in the inferior oblique muscle with secondary shortening and reduction in tone of the superior oblique with secondary elongation, similar to what happens in sensory [mediccreview.org]
Neurologic
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Nystagmus
BACKGROUND: In a previous study we investigated the advantages and drawbacks of early and delayed injection of botulinum toxin as primary treatment of infantile esotropia with nystagmus in abduction (IENA). [ncbi.nlm.nih.gov]
All clinical phenomena (crossed fixation, abduction limitation, optokinetic nystagmus) were symmetrical and bilateral, and in a high percentage preoperative examinations are also symmetrical (alignment test under general anesthesia 74%; passive duction [mediccreview.org]
Latent nystagmus occurs in approximately 40% of patients with infantile esotropia. It is a predominantly horizontal jerk nystagmus elicited by occluding either eye. [eyewiki.aao.org]
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Confusion
Congenital esotropia should not be confused with other true congenital deviations (occasionally fixed esodeviations), which can be detected from the first day of life and are clinically well defined. Reported prevalence of the condition varies. [mediccreview.org]
Transient misalignment of the eyes is common up to the age of 3 months and this should not be confused with infantile esotropia. Etiology The etiology of infantile esotropia is unknown. [eyewiki.aao.org]
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Hyperactivity
Costenbader posited that congenital esotropia treatment should be based on weakening the medial rectus muscles to prevent eventual loss of cortical inhibition of hyperactive convergence.[4,5,12,14] This is the rationale for standard treatment: bilateral [mediccreview.org]
Treatment
The outcomes in the 16 patients who had previously received botulinum toxin were compared with those in the 28 patients for whom surgery was the primary treatment. [ncbi.nlm.nih.gov]
Costenbader posited that congenital esotropia treatment should be based on weakening the medial rectus muscles to prevent eventual loss of cortical inhibition of hyperactive convergence.[4,5,12,14] This is the rationale for standard treatment: bilateral [mediccreview.org]
General treatment Medical therapy Occasionally infants with small angle esotropia 30 PD may be corrected with hypermetropic spectacle correction. The timing of amblyopia treatment in relation to eye muscle realignment surgery is debatable. [eyewiki.aao.org]
Prognosis
Some signs may give a clue about the sensory development and the prognosis of the condition. Detection of fixation preference for one eye can be performed by the use of vertical prism test (10-prism diopter test)[6]. [eyewiki.aao.org]
Etiology
Etiology The etiology of infantile esotropia is unknown. Many theories have been postulated regarding the pathogenesis of the disease. [eyewiki.aao.org]
Pathophysiology
The pathophysiology of ischemic injury to developing white matter. Mcgill J Med. 2006; 9(2):134-40. Sirinyan M, Florian Sennlaub F, Dorfman A, Sapieha P, Gobeil F, Hardy P, Lachapelle P, Chemtob S. [revistas.ustabuca.edu.co]
Prevention
Costenbader posited that congenital esotropia treatment should be based on weakening the medial rectus muscles to prevent eventual loss of cortical inhibition of hyperactive convergence.[4,5,12,14] This is the rationale for standard treatment: bilateral [mediccreview.org]