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Ophthalmology. 2008 Dec;115(12):2266-2274.e4. doi: 10.1016/j.ophtha.2008.08.011. Epub 2008 Oct 29.

Instability of ocular alignment in childhood esotropia.

Collaborators (197)

Arnold RW, Armitage MD, Sala NA, Hodde RM, Zeto VL, Hoover DL, Huston PA, Donahue S, Morrison DG, Owings SA, Franklin CC, Palmer NJ, Biernacki RJ, Martin J, Silbert DI, Singman EL, Matta NS, Suh DW, McNeece M, Madsen BS, Andreassen AD, Fergus LM, Swisher RJ, Ticho BH, Khammar AJ, Clausius DA, Summers CG, Bothun ED, Christiansen SP, Holleschau AM, Hogue KM, Merrill KS, Downes SJ, Stager DR, Felius J, Alters MK, Glaser SR, Glaser SR, Addison CY, Emory ME, Glaser PE, Mason JR, Klimek DL, Winter LL, Greenlee BL, Enyedi LB, Freedman SF, Wallace DK, Young TL, Jones SK, Bryant JW, Paysse EA, Coats DK, Yen KG, Edmond JC, Steinkuller PG, Parker ML, Castanes MS, Rosby-Obeng G, Laby DM, Laby DM, Laby R, Weaver RG Jr, Moya AZ, Roberts JT, Perez LG, Klem HM, Sullivan MJ, Wheeler DT, Karr DJ, Stout AU, Beaudet KA, Rauch PK, Schloff S, Host VE, Fishman DR, Verderber LC, Spieker J, Goldblum TA, Alfaro A, Dagi LR, Tyedmers M, MacKinnon SE, Johnson RM, Repka MX, Christoff AX, Goodman CR, Liu X, Bacal DA, Doheny M, Martin D, Holmes JM, Mohney BG, Sease JM, Leske DA, Nielsen RA, Cruz OA, Davitt BV, Miyazaki EA, Lee KA, Lee KA, Schweinler BR, Droste PJ, Peters RJ, Hilbrands J, Neely DE, Whitaker ME, Bartiss MJ, McGaw TF, Poindexter KP, Lambert SR, Robb RA, Levin EM, Jackson JL, Sprunger DT, Roberts GJ, Galli JG, O'Hara M, Bartolacci MM, Atkinson S, Hamlet PK, Levada AJ, Walker TL, Brassett C, Schleif C, Birch EE, Bothun ED, Chandler DL, Christiansen SP, Donahue S, Everett DF, Hertle RW, Holmes JM, Matta NS, Mohney BG, Owens S, Quinn GE, Repka MX, Wallace DK, Weakley DR, Weaver RG Jr, Beck RW, Becker BD, Bernett GN, Boyle NM, Cagnina-Morales CM, Cagnina DA, Cardosa EL, Chandler DL, Clark LE, Constantine SR, Dawson KL, Donahue Q, Drew MD, Dupre M, Horsley KL, Gillespie HA, Kraker RT, Lee SV, Lester LA, Mares ST, McCombs H, Melia BM, Moke PS, Morgan-Bagley S, Pyner JL, Rojas DE, Reese NT, Strayer HJ, Williams D, Everett DF, Beck RW, Birch EE, Christiansen SP, Cotter SA, Donahue SP, Everett DF, Holmes JM, Hoover DL, Huston PA, Kraker RT, Repka MX, Sala NA, Scheiman MM, Wallace DK, Barlow W, Buckley EG, Davis B, Diener-West MD, Dobson V, Keltner JL, Osman H, Palmer EA, Phelps DL, Poff SW, Saunders RA, Tychsen L.

Author information

Jaeb Center for Health Research, 15310 Amberly Drive, Suite 350, Tampa, FL 33647, USA.



Instability of ocular alignment may cause surgeons to delay surgical correction of childhood esotropia. The authors investigated the stability of ocular alignment over 18 weeks in children with infantile esotropia (IET), acquired nonaccommodative esotropia (ANAET), or acquired partially accommodative esotropia (APAET).


Prospective, observational study.


Two hundred thirty-three children aged 2 months to less than 5 years with IET, ANAET, or APAET of less than 6 months' duration.


Ocular alignment was measured at baseline and at 6-week intervals for 18 weeks.


Using definitions derived from a nested test-retest study and computer simulation modeling, ocular alignment was classified as unstable if there was a change of 15 prism diopters (PD) or more between any 2 of the 4 measurements, as stable if all 4 measurements were within 5 PD or less of one another, or as uncertain if neither criteria was met.


Of those who completed all 3 follow-up visits within time windows for analysis, 27 (46%) of 59 subjects with IET had ocular alignment classified as unstable (95% confidence interval [CI], 33%-59%), 20% as stable (95% CI, 11%-33%), and 34% as uncertain (95% CI, 22%-47%). Thirteen (22%) of 60 subjects with ANAET had ocular alignment classified as unstable (95% CI, 12%-34%), 37% as stable (95% CI, 25%-50%), and 42% as uncertain (95% CI, 29%-55%). Six (15%) of 41 subjects with APAET had ocular alignment classified as unstable (95% CI, 6%-29%), 39% as stable (95% CI, 24%-56%), and 46% as uncertain (95% CI, 31%-63%). For IET, subjects who were older at presentation were less likely to have unstable angles than subjects who were younger at presentation (risk ratio for unstable vs stable per additional month of age, 0.85; 99% CI, 0.74-0.99).


Ocular alignment instability is common in children with IET, ANAET, and APAET. The impact of this finding on the optimal timing for strabismus surgery in childhood esotropia awaits further study.


The author(s) have no proprietary or commercial interest in any materials discussed in this article.

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