Use of atropine to predict the accommodative component in esotropia with hypermetropia

Convergence excess consecutive esotropia associated with 0.01% atropine eye drops usage in patients operated for intermittent exotropia

To report convergence excess esotropia (CEET) following 0.01% atropine eye drops (Low dose atropine [LDA]). Children who developed CEET that resolved promptly after discontinuation of LDA are described. Three myopes aged 5.3 ± 1.2 years and mean sphere -4.5D were included. All were operated for intermittent exotropia earlier. Mean esotropia was +28.3PD for near and 10.6PD for distance. LDA induced high AC/A ratio and fusion normalized in 3 weeks after discontinuation of LDA. LDA should be used with caution in patients with esophoria or previously operated for intermittent exotropia. Any evidence of the emergence of a CEET should warrant discontinuation of LDA.

Increase in esodeviation under cycloplegia with 0.5% tropicamide and 0.5% phenylephrine mixed eye drops in patients with hyperopia and esotropia

Backgroud

To evaluate the manifestations of increased esodeviation under cycloplegia with 0.5% tropicamide and 0.5% phenylephrine in children with hyperopia and esotropia.

Methods

We reviewed the medical record of 34 children with hyperopia and esotropia who underwent a prism alternate cover test before and after instillation of mixed eye drops containing 0.5% tropicamide and 0.5% phenylephrine between November 2014 and October 2015. Increased angle of deviation was defined as 10 prism diopters (PD) or greater deviation after cycloplegia. The factors related to increased angle of deviation were evaluated using univariable and multivariable logistic regression analysis.

Results

The median age was 5.0 years (interquartile range, 3.75 to 5.0) and 12 patients (35.3%) were male. The median manifested refractive (MR) was +2.13 diopters (D) (+0.92 to +4.47) and cycloplegic refractive (CR) was +3.50 D (+1.72 to +5.66). The median difference between MR and CR was +0.88 D (+0.50 to +1.28). Thirteen patients (38.2%) showed increased esodeviation under cycloplegia and all had accommodative esotropia. A larger difference between MR and CR was the only significant factor affecting increased esodeviation in both univariable (OR = 4.72, P = 0.029) and multivariable (OR = 5.22, P = 0.047) analyses.

Conclusion

Children with hyperopia and esotropia often showed an increased angle of deviation after instillation of 0.5% tropicamide and 0.5% phenylephrine. This phenomenon reminded the clinicians that cycloplegics can have a different effect on esodeviation and suggested that increased angle of esodeviation may help to reveal the latent deviation in some patients with hyperopia and esotropia.

Strabismus Measurements in Adults Before and After Pupil Dilation

PURPOSE

To determine the effect of dilating drops on strabismus measurements in adults.

DESIGN

Prospective cohort study.

METHODS

Patients aged 18 and older with strabismus underwent a standard evaluation of ocular motility, stereopsis, and ocular alignment with alternate prism cover test by a certified orthoptist. After pupil dilation with 2.5% phenylephrine and 1% tropicamide, ocular alignment was remeasured in primary gaze at 6 meters, at 1/3 meter, and at 1/3 meter with a +3.00 by a second certified orthoptist, masked to the previous measurements. The primary outcome was the mean difference in the angle of horizontal and vertical deviations after dilation in prism diopters.

RESULTS

A total of 55 patients were enrolled with a variety of diagnoses. For horizontal measurements the mean change was 0.54 prism diopters at 6 meters (95% confidence interval [CI] -0.36 to 1.43, P = .24), 1.67 prism diopters at 1/3 meter (95% CI -0.19 to 3.54, P = .08), and -0.05 prism diopters at 1/3 meter with a +3.00 add (95% CI -1.65 to 1.56, P = .95). The mean change in vertical deviation was 0.18 prism diopters at 6 meters (95% CI -0.19 to 0.56, P = .34), 0.57 prism diopters at 1/3 meter (95% CI 0-1.15, P = .05), and 0.47 prism diopters at 1/3 meter with a +3.00 add (95% CI -0.23 to 1.17, P = .18).

CONCLUSIONS

Pupil dilation does not meaningfully affect vertical or horizontal strabismus measurements in adults. Mild variability at near in younger patients is eliminated with the use of a +3.00 add.