A 5-month-old infant presents with a constant inward deviation of the eyes noticed since the first few weeks of life. The deviation measures 40 prism dioptres and remains stable across distances. The infant alternately fixates with either eye using the nasal retina while adducted. What is the MOST likely diagnosis?

• A Accommodative esotropia
• B Congenital (infantile) esotropia ✓
• C Sixth nerve palsy
• D Duane retraction syndrome type 1

Explanation

Infantile esotropia appears before 6 months of age, is characteristically large (30 PD or more), stable, and accompanied by alternate cross fixation, latent nystagmus, DVD and inferior oblique overaction. Accommodative esotropia appears later, typically between 2 and 3 years, is smaller and varies with accommodation, so it is excluded by the early onset and fixed large angle.

Reference: Khurana's Comprehensive Ophthalmology, 7th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.