Is it possible to differentiate early-onset accommodative esotropia from early-onset essential esotropia?

Purpose To determine the frequency of greater than or equal to2.50 diopter ( D) hyperopia in infantile esotropia with onset up to the age of 6 months and by evaluating the treatment results of these cases retrospectively, to find the factors that may help to differentiate early-onset accommodative esotropia from early-onset essential esotropia. Methods The charts of 256 patients with infantile esotropia were reviewed. Thirtyseven cases, with hyperopia of greater than or equal to2.50 D, no other systemic and neurologic disease, and at least 1 year of follow- up, were included in this study. The age at the start of therapy, refractive error, deviation angle, type of therapy (antiaccommodative therapy, surgery) and the presence of amblyopia, latent nystagmus, inferior oblique overaction, dissociated vertical deviation and cross-fixation were recorded for each case. Results The prevalence of high hyperopia was found to be 14.4% (37/256) in infantile esotropia. In 18 of the cases (48.6%), antiaccommodative therapy alone was found to be adequate ( Group I). In the remaining 19, although antiaccommodative therapy was found to decrease the deviation angle significantly (P<0.001), surgery was also required ( Group II). Groups were compared with respect to age at the initial examination, refractive error, deviation angle, presence of amblyopia, anisometropia, and inferior oblique overaction, but no factor could be determined to predict the pure refractive ones (P>0.05). Essential infantile esotropia-associated findings did not help because they are rarely evident at the time of initial diagnosis. Conclusions Half of the high hyperopic infantile esotropes could be corrected fully by antiaccommodative therapy alone, while the remaining ones could also benefit significantly. It is strongly recommended to try spectacles at first in the treatment of infantile esotropia with hyperopia greater than or equal to2.5 D.