Convergence excess accommodative esotropia: a descriptive review of patients presenting over a period of 10 years

Abstract

Aim: Convergence excess accommodative esotropia describes an esotropia on accommodation at near fixation that is controlled to an esophoria/orthophoria at distance fixation with binocular single vision. Sixty-four cases have presented to the Leeds Teaching Hospitals NHS Trust over the last 10 years. This descriptive paper outlines the clinical characteristics of this cohort of patients. Methods: Information was reviewed regarding all children diagnosed as having convergence excess accommodative esotropia entered onto a departmental database between 1999 and 2009. Results: Only 3 children complained of diplopia at presentation. The mean refractive error of the group was right þ2.90DS and left þ2.80DS. The median angle of deviation was 25ΔBO at 1/3 m and 4ΔBO at 6 m. The mean Ac/A ratio using the gradient method was 6:1 at 1/3 m and 10:1 at 6 m. The angle of deviation was found to be altered by a period of monocular occlusion and prism adaptation. Twenty per cent of children required occlusion for amblyopia. Nine per cent of those with convergence excess were found to decompensate to constant esotropia with time. Conclusions: Testing distance, a period of monocular occlusion and prism adaptation have been shown to alter the angle of deviation and the Ac/A ratio in convergence excess accommodative esotropia. Similarities between convergence excess and fully accommodative esotropia are outlined.

Keywords

• Accommodative convergence to accommodation (Ac/A) ratio
• Convergence excess esotropia