This 6-year-old boy has had an esodeviation beginning at three years of age. He was the product of normal pregnancy and delivery. Birth weight was 3.5 kg. Early development was normal until this strabismus was noted with all milestones reached on time. This visit at age 6 years is the first time the child has seen an ophthalmologist. He is an only child.
At this examination, visual acuity is OD 20/100 and OS 20/20. Cycloplegic refraction is OD +3.75, OS +2.50. A right esotropia of 40 prism diopters is measured in the primary position. The child has strong preference for fixation with the left eye. Ductions are normal in each eye and versions demonstrate a comitant 40 prism diopter esodeviation. This deviation is also measured 40 prism diopters at near while fixing on an accommodative target. On further examination of the eyes, the anterior segment and media are clear and the fundus is normal.