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Schiavi C., Scarale M. E.
Department of Ophthalmology, University of Bologna, Bologna, Italy
Combination of esotropia and myopia is uncommon. The association of these anomalies very frequently determines diagnostic and therapeutic problems, mostly as regards the response to surgery that is often not satisfying. There may be cases of casual association of essential esotropia or esophoria which are congenital conditions without known causes, and myopia, where myopia progressively develops often replacing an original hypermetropia, and cases where myopia, per se, seems to be somehow involved in the pathophysiology of esotropia. These latter include infantile esotropia of children with low to moderate uncorrected myopia and far point of accommodation that is forcedly near, comitant normosensorial esotropia that is called “Bielschowsky acute esotropia”, and restrictive esotropia in high myopia which sometimes assumes the form of “heavy eye syndrome” where one or both eyes are forced inward and downward. Infantile esotropia caused by uncorrected myopia requires full optical correction of the myopia, as a treatment. A possible role of a presumed accommodative dysfunction has recently emerged as a causative element for acute comitant myopic esotropia and atropinisation has been proposed, as a substitute for surgery. Recent studies with magnetic resonance coronal images has made possible to obtain great advances in the knowledge of pathophysiology and in surgical management of restrictive esotropia in highly myopes.