Surgery often is needed when optical treatment is delayed. Surgical treatment typically entails recession or weakening of the inward-pulling medial rectus muscle in each eye. Surgery is performed for the nonaccommodative component only. The operation is not intended to discontinue use of glasses. Stable patients typically are seen every 6 months.
Cycloplegic refraction is repeated at least annually and any time esotropia worsens.
Early treatment of amblyopia may result in improved vision, leading to a better prognosis for development of binocular vision and a more stable alignment if surgery is required. Most patients can be weaned from their bifocals by the time they are teenagers. Managing nonrefractive accommodative esotropia can be difficult and frustrating because patients may vary in their ability to fuse despite faithful wearing of glasses. Basic Ophthalmology for Medical Students and Primary Care Residents. Pediatric Ophthalmology, A Text Atlas.