Intermittent esotropia in children

We all know that intermittent exotropia is a common disease. Most exotropias develop early in life. Except for a few cases, exotropia starts as an inconspicuous exotropia, and then develops into obvious intermittent and constant exotropia with age. Intermittent exotropia has many causes, both congenital and acquired. Intermittent exotropia can seriously affect the development of the patient's visual function depending on the age of onset. If the patient meets the surgical indications, early surgical treatment should be considered. So let’s find out what to do if children have intermittent strabismus!

1. Intermittent exotropia

The symptoms are sometimes slanted and sometimes normal. It is easy to show strabismus when you are tired, looking far away, in the sun or not concentrating. However, it will return to the normal state after being reminded by others or through self-control. Intermittent exotropia generally increases in frequency with age and eventually turns into constant strabismus.

The timing of surgery is based on the frequency of strabismus rather than age. If the frequency of strabismus is high, surgery is recommended when closing one eye in strong light. The mainstream international view does not recommend surgery before the age of 4 years old, because intermittent exotropia is caused by poor development of the brain's fusion function. Before the age of 4 years old, the brain's fusion function is constantly developing, and strabismus may change significantly.

2. Pseudoesotropia

Esotropia is also commonly known as "cross-eyed". Some young children who appear to have "crossed eyes" do not have true esotropia, but rather a false esotropia due to a low nose bridge, a wide nose bridge, epicanthus, etc. The appearance of "cross-eyed" tends to improve with age. If a small number of children still look cross-eyed when they grow up, they need to see a plastic surgeon instead of undergoing strabismus surgery. How to identify whether it is pseudo-esotropia? Shine a flashlight on the bridge of the nose and look at the reflective spots on the black eyeballs. If the reflective spots are located in the center of the two black eyeballs, it indicates pseudoesotropia; if the reflective spots are located in the center of one black eyeball and the reflective spots of the other black eyeball are not in the center, it indicates true strabismus.

3. True esotropia

1. First, use the slow mydriatic drug atropine to dilate the pupil for eyesight test. Atropine should be dripped twice a day for 5 days, and each drop should be the size of a grain of rice. Note that because atropine has a vasodilatory effect, if too much is dripped, the child will have dry mouth, flushed face and even fever, but the symptoms will subside when atropine is stopped. If the child does not cooperate, it is recommended to drip it after the child falls asleep at noon or at night. If too much drips, you can suck some out.

2. If the patient has farsightedness after atropine mydriasis refraction, he or she must wear glasses and have a follow-up examination after wearing the glasses for two months.

3. If the esotropia disappears after wearing glasses, surgery is not possible, as it will turn into exotropia after surgery. If the esotropia disappears after wearing glasses, wearing glasses will gradually correct the strabismus. If the esotropia disappears after wearing glasses, but may become more obvious after taking off the glasses, this is normal because wearing glasses exposes the hidden part of the esotropia.

4. If esotropia still exists after wearing glasses, surgical correction is required.

5. Esotropia seriously affects the development of binocular vision function, so early surgery is emphasized, generally requiring surgery before the age of 2 years.