Convergence excess ET (CXE) is an esotropia with binocular single vision (BSV) at distance fixation but esotropia on accommodation for near fixation with near distance disparity (1). In this retrospective chart review our 1ry question:to evaluate the initial treatment to address CXE, whether this treatment successful or not, secondary question: to evaluate primary and final outcomes for control of near esotropia. Successful outcome defined as residual distance and near esotropia and near distance disparity of less than 10PD.
We included patients with CXE managed at Moorfields Eye Hospital from 2003 until 2022, defined as ‘esotropia with BSV at distance but esotropia on accommodation for near with near distance disparity over 8-10 PD while the eye is corrected with the full cycloplegic refraction’. All age groups were included, amblyopic eyes were excluded.
668 patients were reviewed from 2005-2022, the mean age was 7.9years (+/- 6), first line treatment was bifocal glasses in 60%, which was successful in 83%, bi-medial recession was offered to 12.5%, only ¼ of which were improved, Botulinum toxin administered to 3%, bimedial posterior fixation sutures done in 1.5% which did not improve condition. Other lines included single vision glasses and Bangerder foil to relieve double vision. The final outcome was well controlled esophoria in 65% of cases. Binocular single vision achieved in 28%.
The management of convergence excess esotropia is still controversial, in our cohort most patients were managed with bifocals, the final motor and sensory outcomes were variable between patients. More than half of patients had satisfactory motor alignment. However, the sensory outcome was much less.
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