Esotropia and Exotropia Preferred Practice Pattern®
Esotropia and Exotropia Preferred Practice Pattern®
| Created | |
|---|---|
| Tags | Pediatric |
| Journal | Ophthalmology |
| Status | 審查完成 |
| 校稿者 | 蕭靜熹 醫師 |
中文摘要
眼科的Preferred Practice Pattern®指南強調對斜視和弱視患者進行及時和適當的治療的重要性。在一些情況下，兒童的斜視可能會在沒有治療的情況下自行消失，而在其他情況下，可能需要進行手術干預。像Worth 4-Dot Testing和立體視力測試等評估應該進行，以評估兒童的雙眼狀態。Retinoscopy需要充分的睫狀肌麻痺，視神經檢查對於檢測水腫、蒼白或先天異常等徵象至關重要。
如果眼鏡和弱視治療無法緩解內斜視，應考慮進行手術矯正。對於幼兒內斜視，早期手術矯正可能會改善立體感。對於間歇性外斜視的情況，應先採用保守治療方式。過度矯正的凹透鏡(overcorrecting minus-lens)治療雖然有效，但結果通常是暫時性的，並可能導致近視的加劇。定期的追蹤和全面的眼科檢查對於監測患者的進展並確保在需要時提供適當的屈光幫助非常重要。
English Abstract
The Preferred Practice Pattern® guidelines for eye care emphasize the importance of timely and appropriate treatments for patients with strabismus and amblyopia. In some cases, strabismus in children may resolve without treatment, while in others, surgical intervention may be necessary. Assessments like the Worth 4-Dot Testing and stereoacuity tests should be performed to evaluate a child’s binocular sensory status. Accurate retinoscopy in children requires adequate cycloplegia, and optic nerve evaluations are crucial for detecting signs of swelling, pallor, or congenital anomalies.
Surgical correction should be considered for children with esotropia if eyeglasses and amblyopia management prove insufficient. For infantile esotropia, early surgical alignment may improve stereoacuity outcomes. In cases of intermittent exotropia, conservative methods should be employed before surgery. Overcorrecting minus-lens therapy has shown effectiveness, but results are often temporary and may lead to a myopic shift. Regular follow-ups and comprehensive ophthalmic examinations are essential for monitoring patients’ progress and ensuring proper refractive aids are provided when needed. Further studies are necessary to assess the long-term impact of these interventions across diverse populations.
HIGHLIGHTED FINDINGS & RECOMMENDATIONS FOR CARE
Strabismus in children under 4 months of age sometimes resolves without treatment, particularly if the deviation is intermittent, variable, or measures less than 40 prism diopters.
Repeat cycloplegic refraction is indicated when esotropia does not respond to an initial prescription for hyperopia or when esotropia recurs after surgery.
Acquired esotropia should be evaluated and treated promptly.
Young children with intermittent exotropia and good fusional control can be followed without surgery because there is a low rate of deterioration to constant exotropia or reduced stereopsis.
Indications for surgery in intermittent exotropia include a progression to constant or nearly constant deviation, reduced stereopsis, and/or a negative effect on social interactions.
Unilateral recess-resect and bilateral lateral rectus recessions are both effective initial surgical procedures for the treatment of intermittent exotropia.
Convergence insufficiency occurs in children and adults, and symptoms with near viewing can often be improved using vergence exercises.
