Comitant strabismus

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Proprioceptive receptors have long been known anatomically to be present in extraocular muscles, specifically at the myotendinous junction. Their function in regulating smooth pursuits is experimentally demonstrated. The clinical significance of this for strabismus is still unknown. Esotropia surgery before resolution of moderate amblyopia is not detrimental. Botulinum toxin injections will correct infantile esotropia but require more anesthesia sessions overall than does conventional surgery, increasing cost. Late-onset comitant esotropia is usually refractive in nature and rarely neurologic. Comitant esodeviation is also prevalent in children with known neurologic insults. In both situations, it is the associated neurologic signs that point to the underlying neurologic cause. Posterior fixation suture will correct a high accommodative convergence/accommodation ratio esotropia. Exotropia negatively affects patients' quality of life. Surgical outcomes differ in patients whose angle of deviation increases with 1 hour of occlusion testing at extreme distances (“outdoor sensitivity”). Recession resection influences the distance and near angles of deviation equally whereas bilateral lateral rectus resection influences the distance deviation more than the near. Spray administration of cycloplegic agents to closed eyelids has been shown to be as effective as administration of eye drops. The spray is much better tolerated by patients and easier to administer. Photorefraction, although not yet effective as a screening tool, is useful to document alignment and refractive errors.

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