Infantile Esotropia - Surgery

What are the aims of treatment for an infantile esotropia. What does surgery involve and what are the complications of treatment?

Video Transcript:

How are the eyes straightened?

The most common form of treatment for infantile esotropia is surgery to weaken the inner muscles of both eyes. The timing of surgery will differ from surgeon to surgeon, but will normally be carried out between 6-12 months of age. Surgery is not usually carried before 6 months of age as it can be difficult to accurately measure the angle of the squint in these younger children and surgery is technically more difficult in this age group.

To have any chance of developing binocular vision the child's eyes need to be aligned within 3-4 degrees of being straight following surgery.

If the inferior oblique muscles are overacting they will also be weakened at the same time. Surgery to the inferior oblique muscles can also be performed to treat DVD.

How successful is surgery?

Following surgery 10% of children will develop good binocular vision, 50% will develop a lesser degree of binocular vision (known as mono-fixation syndrome) and 40% will have no binocular vision.

What are the complications of surgery?

The most common complications of surgery are either over or undercorrection of the squint.

Over correction resulting in a divergent squint occurs in fewer than 10% of patients. If this occurs further surgery to strengthen the inner muscle(s) of the eye(s) may be needed.

If after 2 months the eyes are still not aligned to within 5 degrees further treatment may be necessary. This could be in the form of botulinum toxin treatment to the inner muscles of the eyes, or further surgery if there is still a large angle squint.