The timing of surgical alignment for congenital (infantile) esotropia.

At this time, the beneficial effect of accurate alignment by age 2 in congenital esotropia has been well established by clinical and laboratory studies. There is, however, only scanty clinical evidence that alignment before age 1, much less before 6 months of age, may yield a better quality of binocularity (i.e., refined stereoacuity) than alignment by age 2. Pitfalls of very early alignment are present. In addition, the ophthalmologist must be vigilant in following the initially aligned patient and be ready to treat vertical motor defects, amblyopia, and acquired refractive errors. The need for additional horizontal surgery after initial alignment is also common. The optimum result in the surgical treatment of congenital esotropia generally shows binocularity that is within the confines of a monofixation syndrome, and refined stereoacuity remains an elusive target and a rare outcome, no matter at what age the alignment is achieved.