Note

Infantile esotropia does not prevent sixth nerve palsies.

Fig. 10.8. Intermittent spasms of the near reflex. First image (top) Normal eye positions, pupils at mid-dilation, normal acuity. Second image Sudden onset of a right esotropia, pupillary miosis, blurred vision. Third image At right gaze position the left eye takes up fixation, and right eye appears to have abduction deficit. Fourth image After encouraging maximal gaze effort to the right, or after brief occlusion of the adducting eye, the right eye is shown to have a normal range of abduction

Fig. 10.8. Intermittent spasms of the near reflex. First image (top) Normal eye positions, pupils at mid-dilation, normal acuity. Second image Sudden onset of a right esotropia, pupillary miosis, blurred vision. Third image At right gaze position the left eye takes up fixation, and right eye appears to have abduction deficit. Fourth image After encouraging maximal gaze effort to the right, or after brief occlusion of the adducting eye, the right eye is shown to have a normal range of abduction

Trochlear Palsies

A large esophoria will decompensate into a manifest esotropia when there is a loss of vision in one eye. This sort of presentation will be associated with an afferent pupillary defect as a part of a retinal and/or optic nerve disorder, but can also be the result of a dense monocular clouding of the optic media. It will simulate an abduction deficit in the eye with visual loss. The undamaged eye will take up primary fixation, and pursuit of movement toward the affected side will commonly induce a head turn at the far end of the movement, as the patient compensates for a masking of the target by the bridge of the nose.

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