Persistently recurrent infantile esotropia

Introduction: Children with infantile esotropia often require more than one surgery to align the eyes horizontally, for either recurrent esotropia or consecutive exotropia. We report an unusual subset of patients who had persistently recurrent esotropia despite multiple surgeries. Methods: The records of 11 patients who presented before age one year with infantile esotropia and who had three or more surgeries for recurrent esotropia were reviewed. The number of surgeries, outcomes, and associated systemic conditions were recorded. Results: These 11 patients represented 4% of children who were operated upon for infantile esotropia during the time of the study. The number of surgeries per patient ranged from 3-9 (mean 5). All of the horizontal surgeries in eight patients were for esotropia, while three patients developed exotropia after three or more surgeries for esotropia. Three children were otherwise normal, three had mild nonspecific developmental delay, one was premature, one had Trisomy 21, and one had spina bifida and high myopia. Following their most recent surgery, eight children had deviations of 8^Δ or less, and three had deviations between 8^Δ and 16^Δ. Seven patients demonstrated fusion. Age at last follow-up ranged from 2-13 years (mean 6.7 years). Conclusion: Persistently recurrent esotropia is an unusual occurrence in children with infantile esotropia. Developmental delay is common in these patients, although none were markedly delayed. Satisfactory ocular alignment can be achieved in most patients, but several surgeries may be necessary to achieve this.