The authors present a retrospective case review of individuals with primary divergence insufficiency or age-related distance esotropia, over a 15-year period. Inclusion criteria allow for the difference between near and distance angles to be patient reported or objectively measured. One or more associated features of sagging eye syndrome also had to be present; baggy eyelids, deformity of superior sulcus or aponeurotic blepharoptosis. Other aetiologies of strabismus were excluded including childhood strabismus. Additional exclusion criteria were incisional glaucoma surgery and significant head or facial trauma. The following data was extracted from the medical records; demographics, follow-up period, angle of deviation on presentation, change in angle of deviation, treatment provided, neuroimaging acquired and past medical history. A total of 89 cases were included in the study, 66% were female, with a mean age of 77 years. For those seen in clinic on more than one occasion (n=56) the mean follow-up was 25 months. The majority of cases were treated with Fresnel prisms. Only seven cases elected for a surgical option. The size of the presenting angle of deviation was 6.6 prism dioptres, excluding surgical intervention. The angle of deviation increased over the follow-up period to 8 prism dioptres. The authors acknowledge the retrospective methodology of the study as a limitation, in addition to the clinic being non-surgical which may bias this study to smaller angles of deviation. This study highlights the effectiveness of prisms as a treatment strategy in this group of patients with small angle distance esotropia.
Age-related distance esotropia – what are the clinical characteristics?
Reviewed by Lauren Hepworth
Demographic and clinical characteristics of age-related distance esotropia.
CONTRIBUTOR
Lauren R Hepworth
University of Liverpool; Honorary Stroke Specialist Clinical Orthoptist, Northern Care Alliance NHS Foundation Trust; St Helen’s and Knowsley NHS Foundation Trust, UK.
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