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Progression of Intermittent, Small-Angle, and Variable Esotropia in Infancy

¹From the Pediatric Eye Research Laboratory, Retina Foundation of the Southwest, Dallas, Texas; and the ²University of Texas Southwestern Medical Center, Dallas, Texas.

PURPOSE. Esotropia (ET) in infancy may initially manifest as a small-angle, variable-angle, or intermittent deviation. Some patients experience spontaneous resolution and become orthophoric. Others progress to constant large-angle ET and require surgery. The authors examined factors that may be associated with risk for progression to constant large-angle ET.

METHODS. Seventy-seven infants who initially presented with intermittent, small (<20 prism diopter [pd]) or variable-angle ET at 2 to 12 months of age were followed up until the ET was resolved, the infants had surgery, or the parents or guardians refused surgery. All infants with refractive correction +3.50 D were treated initially with glasses. Four risk factors were examined: prescription of occlusion therapy, initial visit before 6 months of age, presence of amblyopia, and abnormal stereoacuity.

RESULTS. All 12 infants with small or variable angles progressed to constant large-angle ET and surgery. ET resolved spontaneously in 44.6% (29/65) infants in whom it was intermittent. Infants with intermittent ET who received patches as initial treatment and who had abnormal stereoacuity had 3.4x (95% confidence interval [CI], 1.83–6.29) and 3.4x (95% CI, 1.66–6.78) higher risk for progression to constant large-angle ET, respectively. Neither age at initial visit nor amblyopia presented risk for progression.

CONCLUSIONS. Abnormal stereoacuity and occlusion therapy pose significant risks for progression from intermittent to constant large-angle ET. Intermittent ET that develops during the first year of life has a high likelihood of spontaneous resolution, whereas constant small-angle or variable-angle ET seldom resolves.

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