A 5-year-old child with no glasses presents with esotropia measuring 30 prism dioptres (PD) at both distance and near. Cycloplegic refraction reveals +5.00 D hypermetropia bilaterally. After full refractive correction with spectacles, the esotropia reduces to 8 PD at near but 22 PD at distance. This is most consistent with:

• A Fully accommodative esotropia
• B Non-accommodative esotropia requiring surgical correction
• C Partially accommodative esotropia ✓
• D Convergence excess esotropia

Explanation

Partially accommodative esotropia is diagnosed when spectacle correction eliminates only part of the deviation, with a residual deviation remaining. In this case, 8 PD remains after glasses — treatment requires spectacles to correct the accommodative component plus surgical correction (bilateral medial rectus recession) to address the non-accommodative residual angle. Fully accommodative esotropia is corrected entirely by spectacle correction with zero residual deviation. Non-accommodative esotropia shows no reduction in deviation with glasses. Convergence excess (high AC/A ratio) shows greater near deviation than distance deviation — here distance deviation is greater.

Reference: Khurana Comprehensive Ophthalmology, 7th ed.

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Written and medically reviewed by the StethoPrep medical team.