Surgical treatment typically entails recession or weakening of the inward-pulling medial rectus muscle in each eye. In cases involving amblyopia, surgery can be limited to only the amblyopic eye by performing a recession of the medial rectus and a resection or strengthening of the lateral rectus. Surgery is performed for the nonaccommodative component only. The operation is not intended to discontinue use of glasses. Typically, stable patients 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. With patients aged 4-5 years, one can attempt to reduce the strength of the hyperopic correction to enhance fusional divergence and to maximize visual acuity. If glasses are worn faithfully and fusional patterns are established, many patients with refractive esotropia can maintain straight eyes without wearing glasses by the time they are teenagers. The Merck Manual of Diagnosis and Therapy. Basic Ophthalmology for Medical Students and Primary Care Residents.