Refractive Correction and Penalization for Patient with Accomodative Esotropia and Amblyopia: A Case Report

Abstract

Refractive disorder is one of the most common cause of visual impairment in the world and the second cause of preventable blindness. One of the main problems in children with untreated refractive disorder is amblyopia, which is the inability of the eye to achieve the best visual acuity even with the maximum correction. Furthermore, in children with refractive disorder also possible to develop strabismus, one of them is accomodative esotropia. This case report was made to describe a case of accomodative esotropia with amblyopia and good therapeutic result with maximum refractive correction and atropine penalization therapy on a female, 4 years old patient, with complain of squint inward eyes since she was 1.5 years old. History of spectacle use since she was 2 years old. On the examination was found esotropia 45⁰, with visual acuity without spectacles 6/60 for both eyes. Visual acuity with spectacle S+2.75 C-1.00x180⁰ was 0.8 on the right eye and 0.4 with spectacle S+5.00 C-2.00 x165⁰ for the left eye. Subsequently, patient was underwent streak retinoscopy and given glasses prescription with S+9.00 C-1.25 X180⁰ for the right eye and S+9.50 C-1.50x0⁰ for the left eye. On the follow up patient was planned to get penalization with Atropin 1% eye drop twice a day on the right eye and was planned for follow up every 3 months. After 2 years of penalization therapy, the best corrected visual acuity was improved became 0.8 on the right eye with spectacle S+9.50C-1.50 X180⁰ and 1.0 on the left eye with spectacle S+10.00 C-1.50 X0⁰, the binocular visual acuity was 1.0 and the Hirschberg test shows orthophoria with and without correction. This case explains that refractive correction and penalization therapy could be a good alternative therapy to treat accomodative esotropia and amblyopia.