2021 Top Story in Eye Care: Consecutive Esotropia Following Surgery for Basic Intermittent Exotropia
A subset of patients with intermittent exotropia who appear to be aligned during the postoperative period may convert to consecutive esotropia over time, requiring active follow-up. This presents an opportunity for potential synergy between optometrists and ophthalmologists in the proactive co-management of the child with strabismus.
An article published in February 2021 in Eye1is notable in showing that a subset of patients with intermittent exotropia who appear to be aligned during the postoperative period may convert to consecutive esotropia during a time course ranging anywhere from 6 months to 3 years. In this study, risk factors for delayed-onset consecutive esotropia were a larger preoperative angle and younger age at the time of the operation. Those involved with the care of these patients should therefore be vigilant in monitoring patients with intermittent exotropia postsurgically, at least at 6-month intervals over a 3-year time period, or more frequently where there are early signs of decompensation. The majority of patients undergoing eye muscle surgery tend to be monitored closely by the pediatric ophthalmologist in the immediate postoperative phase but less formally in the ensuing months and years. This opens the door to a new standard of care in which optometrists play a crucial role in monitoring these patients at appropriate intervals, providing nonsurgical support in terms of lenses, prisms, and other forms of therapy to help stabilize the postsurgical outcome and reduce the need for subsequent surgeries.
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