DR.SHAMIKA GHAISAS

Dr.Sujata Guha, Dr.MANIDEEPA BANERJEE

Abstract

Accommodative esotropia (AET) is typically seen in hypermetropes and is rare in emetropes or myopes. We report the management of an unusual case of AET with a high accommodative convergence by accommodation (AC/A) ratio in a myopic patient. Four years old girl presented with an inward deviation of the eyes. She had an esotropia of 25 prism diopters (PD) for distance and 40 PD for near suggestive of high AC/A. On cycloplegic refraction she had a myopic refraction. She was prescribed bifocals and her near deviation reduced. Over 7 years follow up, her esotropia and AC/A ratio reduced. She was gradually weaned off her bifocals and achieved good alignment and stereopsis. We propose that after myopia is corrected, there is a need to accommodate for near which was absent in uncorrected myopia, which leads to a transient esotropia for near. In patients with a high AC/A ratio, or poor divergence amplitudes this may precipitate a clinical esotropia.