A 27-year old Nepali man presented with a four-day history of fever, vomiting and horizontal diplopia. There was no history of trauma. The patient has esotropia of the left eye or what is commonly known as a squint or strabismus. The squint is an inward squint (synonyms include convergent squint or esodeviation of the eye). Esotropia is a condition where either one or both eyes are turned inward. Congenital esotropia, often seen in infants below six years old, may give rise to amblyopia. Accommodative esotropia is common among patients with moderate amounts of
hypermetropia or hyperopia. Esotropias can be concomitant, where the degree of deviation is independent of the direction of the gaze, or incomitant, where the degree of deviation is influenced by the direction of the gaze. This patient had incomitant esotropia as the squint was revealed when he was asked to look to the left. A comprehensive step-bystep approach to a patient presenting with a squint has been described extensively in literature.
This study was conducted to compare the treatment outcome using patching in patients with strabismic amblyopia and refractive amblyopia. The treatment outcome was measured by visual acuity and refractive error. A total of 28 patients participated in this study. One group comprised of strabismic amblyopes who had either congenital esotropia or intermittent exotropia and spherical equivalent refractive error of less than -3.00 DS. Another group of patients were purely refractive amblyopes. Patients were first corrected with the best correction for a month. When the VA in the amblyopic eye did not improve over the month, then patching treatment was started. Patching was done daily for 2 h together with near activity. The treatment was carried out for 4 months, with the patients reviewed once every month. The results of the study revealed that VA improved by 17 alphabets or 3 lines after patching treatment for patients with strabismic amblyopia. In the refractive amblyopia group, the VA only improved by 8 alphabets or 1 line 3 alphabets. The mean spherical equivalent refractive error changed by less than -0.50DS and therefore was clinically not significant in both groups. This present study showed that patching treatment was better at improving the VA of patients with strabismic amblyopia.
BACKGROUND: A retrospective study was undertaken to examine the hypothesis that esophoria is associated with higher amounts of myopia. METHODS: One hundred and forty-four subjects were selected from the files of optometry clinics at the Department of Optometry, National University of Malaysia, from the years 1995 to 1998 inclusive. These subjects were matched in terms of age group, sex, race and near phoria group. Near phorias were determined by Maddox wing technique and were classified into three groups: more than six prism dioptres exophoria, zero to six prism dioptres exophoria and any esophorias. RESULTS: One way analysis of variance revealed that there were significant differences in mean myopias between the three phoria groups (ANOVA, F(2,141) = 5.34, p < 0.01). Further analysis with the Student-Newman-Keuls test showed that the amount of myopia is significantly higher in the esophoric group than in the other two groups. CONCLUSIONS: The results support the hypothesis that near esophoria is associated with high myopia. This study suggests that near phoria might be an important factor in myopia development.