Examine the fundus with both direct and indirect ophthalmoscopes. Note the appearance of the macula and the optic nerve. Perform cycloplegic refraction on all children by using the retinoscope and loose lenses. Early treatment of amblyopia by patching the normal eye is the mainstay of treatment. Surgery may be required if the esodeviation becomes refractory to optical treatment.
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.