A 4-year-old child is found to have a unilateral esotropia of 35 prism diopters with hypermetropia of +5.0 D in the deviating eye and +5.5 D in the fellow eye. The first and most important step in management is:
- A Full cycloplegic refraction and spectacle correction of the full hypermetropic error ✓
- B Immediate surgery for the esotropia
- C Occlusion therapy of the fixing eye
- D Botulinum toxin injection into the medial rectus
Correct answer: A. Full cycloplegic refraction and spectacle correction of the full hypermetropic error
Explanation
In accommodative esotropia (the most common type of childhood esotropia), the deviation is driven by excessive accommodative convergence in response to uncorrected hypermetropia. Full correction of the hypermetropic refractive error with spectacles (after cycloplegic refraction) reduces the accommodative demand and may completely or partially correct the esotropia. Surgery is deferred until after 3–6 months of full spectacle wear to assess residual non-accommodative deviation. Occlusion is used to treat amblyopia but does not correct the deviation itself.
Reference: Khurana Comprehensive Ophthalmology, 7th ed.
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