Siti Faeza Hanim, A CASE OF DECOMPENSATED ESOPHORIA WITH DIPLOPIA

A CASE OF DECOMPENSATED ESOPHORIA WITH DIPLOPIA Siti Faeza Hanim, Sit Jo Anne, Haizan Farah Department Ophthalmology Hospital Selayang NMRR ID-23-02226-PJM. Decompensated Esophoria is a latent inward misalignment that becomes manifest to esotropia and symptomatic.1 Symptoms of Decompensated Esophoria may range from simple headache to severe asthenopia and binocular diplopia.1 The purpose of this case report is to describe the possible treatment for Decompensated Esophoria with diplopia. An 18-year-old male was referred to Orthoptic Clinic due to increasing frequency of double vision over past three months. He was born prematurely at week 28 via Emergency Lower Segment Caesarean Section (EMLSCS). His ocular health was monitored by Ophthalmologist since birth and subsequently discharged normal. Parents noted intermittent right eye squint at the age of 9. However, patient did not complaint of double vision until 3 months ago. Medical history of patient is otherwise unremarkable. RE LE VA (unaided) 6/6 6/6 Worth 4 Dots - Near: - Distance: Uncrossed diplopia Uncrossed diplopia Stereopsis Nil EOM FULL (duction & version) Near Point of Convergence To the nose Amplitude of Accommodation (Exp. Age 12.5 ±2) 7D, 7D, 8D 9D, 9D, 9D Binocular: 10D, 10D, 10D Refraction Plano 6/6 Plano 6/6 Atropine refraction +1.00DS 6/6 +1.00DS 6/6 Hess Test See Picture 1 Cover test/ Prism Cover Test (with and without spectacle) Near: RE Esotropia to Alternating Esotropia (varies from 25PD to 40PD BO) Distance: RE Esotropia to Alternating Esotropia (varies from 25PD to 40PD BO) Post op diplopia test Near: single vision up to 35PD BO Distance: Intermittent single vision up to 40PD BO Introduction Case Description We would like to thank Ophthalmology Department Hospital Selayang and Optometry Unit Hospital Selayang for all the support in this study. Acknowledgement References Intervention 1. Occlude one eye - temporary 2. Prescribed spectacle prescription 3. Prism prescription - for small angle 4. Suggest for squint surgery - for large angle - Squint surgery done – with Bilateral Medial Rectus recession of 4.5mm, aim for 30PD Outcome (Post Operative) Stereopsis (Frisby) 55” of arc EOM FULL Prism Cover Test Near: Orthophoria Far: Esophoria with 12PD BO Discussion Surgical management is proposed for patients with large angle of deviation.2A prolonged alternate prism cover test should be practised to suspend tonic fusional vergence to overcome the variable angle of esodeviation.3 Conclusion Decompensated Esotropia with diplopia is treatable with bilateral medial rectus recession.2 1. Ali MH, Berry S, Qureshi A, Rattanalert N, Demer JL. Decompensated Esophoria as a Benign Cause of Acquired Esotropia. Am J Ophthalmol. 2018 Oct;194:95-100. doi: 10.1016/j.ajo.2018.07.007. Epub 2018 Jul 24. PMID: 30053478; PMCID: PMC6438619 2. Godts D, Mathysen DG. Distance esotropia in the elderly. Br J Ophthalmol 2013;97(11):1415–1419. 3. Bhola R. (2006, January 19). Intermittent Exotropia: A Major Review. Ophthalmology and Visual Sciences. https://webeye.ophth.uiowa.edu/eyeforum/tutorials/intermittent-exotropia.htm Picture 1