Question:
Dear Doctor: My son (18 mos. old) has been diagnosed with what
the Doctor assumed to be "Accomodative" Esotropia. She had asked me if I
saw my son's eyes cross since birth, and I was uncertain. I had seen them
cross, however, simply assumed that it was the child trying to focus as his
vision was beginning to improve. She tested him for farsightedness, and he
did test positive for that, however the prescription is only a +2 (or
something like that) He does not wear the glasses, and after confessing
that to the Doctor last visit, she gave us Homatropine drops so that he
would need to wear the glasses to see correctly. (Apparently the prescription alone is so mild that he can't tell that he
can see better with them on, so he doesn't leave them on.) He still will
not wear the glasses even with the drops, and shuts his eyes so tightly
that it is nearly impossible to get the drops in the eyes anyway. We have
grappled with the glasses and with his not wearing them now for 2 mos. His
next appt. with the doctor is in 10 days, and at this time, if the glasses
haven't straightened the muscles, she wants to discuss surgery. I realize
that he hasn't worn the glasses long enough to really make a difference,
and I would like to do the surgery IF it will be better done now than
waiting for later, but I am uncertain as to whether or not time will
"uncross" his eyes, if we should simply try harder to get him to wear the
glasses, or if surgery is really the right action to take. We will get a
second opinion from another doctor prior to taking any action, but I was
very interested in anything you may have to say on this topic. Thank you
very much.
(Lisa Jennings)
Answer:
Dear Lisa,
Please have your child wear the glasses.
One of the reasons for the convergent strabismus is that, as he lacks the
glasses, he has to focus already 2 dioptres when looking in the distance,
and focusing (accommodation) always goes together with convergence (eyes
moving towards nose).
Certainly before surgery the glasses would have to be worn because,
otherwise, only the angle of squint would be measured (and operated !) that
your son has during focusing. The focus fluctuates without the
glasses, however, and so will the angle of squint.
Homatropine is an unpleasant way to force the glasses on, better is full
support by the parents.
The question is whether surgery on short notice will increase your son's
chance of regaining binocular vision. This question already assumes that he
had binocular vision before the onset of the squint, of which we are not
even sure. If surgery is unlikely to improve binocular vision, the reason
for surgery is mainly cosmetic.
Yours truly,
(Herb Simonsz, MD, PhD)
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