Esotropia, accommodative

The major therapeutic uses of the cholinomimetics are for diseases of the eye (glaucoma, accommodative esotropia), the gastrointestinal and urinary tracts (postoperative atony, neurogenic bladder), the neuromuscular junction (myasthenia gravis, curare-induced neuromuscular paralysis), and very rarely, the heart (certain atrial arrhythmias). Cholinesterase inhibitors are occasionally used in the treatment of atropine overdosage. Several newer cholinesterase inhibitors are being used to treat patients with Alzheimer s disease. 

Accommodative esotropia (strabismus caused by hypermetropic accommodative error) in young children is sometimes diagnosed and treated with cholinomimetic agonists. Dosage is similar to or higher than that used for glaucoma. 

Cycloplegia is reserved for a limited number of conditions (e g., suspected latent hyperopia, accommodative esotropia, amblyopia treatment). Hyperopic patients may have shallow anterior chamber angles that require... 

The drug can also be used concomitantly with echo-thiophate to prevent the formation of miotic cysts during treatment of open-angle glaucoma or accommodative esotropia. Addition of the 2.5% concentration to the echothiophate regimen is recommended. The mechanism whereby phenylephrine prevents cyst formation is not known. However, inhibition of the intense miosis may account, at least in part, for the beneficial effect. 

Are there any binocular or accommodative disorders that the refractive correction would improve For example, in the case of refractive/accommodative esotropia, the prescription for hyperopic correction is critical in reducing or eliminating the esotropia. 

Would refractive correction prevent future problems from developing For example, if a preschool-aged child is found to have moderate hyperopia, by prescribing spectacles the clinician may prevent the child from developing refractive/accommodative esotropia. 

Celebi S, Aykan U. The comparison of cyclopentolate and atropine in patients with refractive accommodative esotropia by means of retinoscopy autorefractometry and biometric lens thickness.Acta Ophthalmol Scand 1999 77 426-429. Drug facts and comparisons. St. Louis, MO Wolters Kluwer Health, 2006. 

An additional concern in the use of miotics in lieu of spectacles arises in the case of anisometropia associated with significant hyperopia and accommodative esotropia. 

Repka MX,Wellish K,Wisnicki FIJ, et al. Changes in the refractive error of 94 spectacle treated patients with acquired accommodative esotropia. Binocular Vision 1989 4 15-21. 

Chamberlain, W., 1975 Antichollnestease mlotics In the management of accommodative esotropia. J. Pediatric Ophthal. 12 151-156. 

Echothiophate is a cholinesterase inhibitor that causes miosis, increase in facility of outflow of aqueous humor, a fall in lOP, and potentiation of accommodation by enhancing the effect of endogenously liberated acetylchohne in the iris, ciliary muscle, and other parasympathetic innervated structures of the eye. It is indicated in the treatment of chronic open-angle glaucoma and treatment of accommodative esotropia (see also Figure 12). 

Physostigmine (eserine) 0.25% ointment Glaucoma, accommodative esotropia, louse and mite infestation of lashes Retinal detachment, miosis, cataract, pupillary block glaucoma, iris cysts, brow ache, punctal stenosis of the nasolacrimal system... 

Echothiophate (phospholine iodide) 0.125% solution Glaucoma, accommodative esotropia Same as for physostigmine... 

DFP produces a miosis of rapid onset and prolonged duration. In the treatment of accommodative esotropia with isofluorophate. 

Cholinergic receptor agonists are used in correcting accommodative esotropia, an ocular disease in young children. 

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