Inferior oblique overaction in infantile esotropia: fundus extorsion as a predictive sign.

Abstract

Inferior oblique overaction develops in 72% of patients with infantile esotropia but generally is not recognized until the patient is between 2 and 4 years of age. While undergoing bilateral medial rectus recessions, photographs were taken of the posterior pole of 27 eyes in 14 patients with infantile esotropia and graded for the presence or absence of torsion by a masked observer. Follow up ranged from 10 months to 6 years. Oblique muscle overaction developed in 15 of the 27 eyes. Of these 15, six demonstrated fundus torsion in infancy, before the oblique dysfunction was recognized clinically. The presence of abnormal fundus torsion can serve as a marker for patients with infantile esotropia who ultimately will develop overt oblique muscle dysfunction.