Fully accommodative esotropia
A patient with a right accommodative esotropia which only becomes manifested when looking
at a fixating object close-up
A patient with accommodative esotropia corrected with plus lenses
Left esotropia correctable with plus lenses.
The most common instruction is ' Please perform cover/uncover test on this patient'. The patient may or may not
be wearing their glasses. Ask the patient if he/she wears any glasses because you need to perform the test with
and without glasses.
The patient wears hypermetropic glasses (if this is of the refractive type; in non-refractive type the patient may be
With the glasses on, the corneal reflexes are central in both eyes and the cover/uncover tests were orthophoric for
near and distance (in partially accommodative esotropia there may be esotropia on near fixation but its magnitude
is less compared to without glasses).
With the glasses off, there is an esotropia (which may only be present with near fixation). The esotropia is increased
on near fixation (due to increased accommodation) but is less or absent with distant fixation.
The ocular motility is otherwise normal.
1. Do patients with accommodative esotropia always have significant hypermetropia?