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Comitant Strabismus

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Albert and Jakobiec's Principles and Practice of Ophthalmology

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Abstract

When strabismus is comitant, the angle of deviation is similar regardless of the direction of gaze or the fixating eye. Comitant horizontal deviations are generally not associated with underlying serious CNS pathology; thus, the distinction between comitant and incomitant strabismus is clinically important.

In the first few months of life, normal infants may demonstrate variable degrees of esotropia and/or exotropia. The ideal outcome of early surgery for infantile esotropia is attainment of high-grade stereoacuity. More often the large-angle esotropia is converted to a microesotropia (monofixation syndrome) with the development of peripheral fusion and a central suppression scotoma. It is estimated that infantile exotropia is 150–300 times less common than infantile esotropia. In contrast, transient exodeviations are relatively common in healthy neonates.

In older children, uncorrected hypermetropia and decompensated monofixation syndrome are the most common etiological factors in acquired comitant esotropia. The clinician must recognize that over time comitant forms of strabismus may develop associated features that may not be comitant and thought to reflect poor binocular vision development. These include latent nystagmus, optokinetic nystagmus asymmetry, dissociated vertical deviation, and inferior oblique overaction.

Children with intermittent exotropia and esotropia may have a tendency to squint one eye in bright illumination; hence, the term “squint” has become synonymous with strabismus in some countries. Children with refractive/accommodative esotropia (typically >2.5 diopters of hyperopia) present around age 2–3 years, at a time when toddlers are learning to explore the “near world” at hand.

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Authors and Affiliations

  1. EyeSightMD, Orange, CA, USA

    David Sami

  2. University of Iowa Hospitals and Clinics, Iowa City, IA, USA

    Scott A. Larson

Authors
  1. David Sami
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  2. Scott A. Larson
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Correspondence to David Sami .

Editor information

Editors and Affiliations

  1. Casey Eye Institute, Oregon Health & Science, Portland, OR, USA

    Daniel M. Albert

  2. Department of Ophthalmology, Massachusetts Eye and Ear, Massachusetts General Hospital, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA

    Joan W. Miller

  3. Department of Ophthalmology, University of Illinois College of Medicine, University of Illinois at Chicago, Chicago, IL, USA

    Dimitri T. Azar

  4. Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA

    Lucy H. Young

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  1. No affiliation provided

    Michael Chiang

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Sami, D., Larson, S.A. (2022). Comitant Strabismus. In: Albert, D.M., Miller, J.W., Azar, D.T., Young, L.H. (eds) Albert and Jakobiec's Principles and Practice of Ophthalmology. Springer, Cham. https://doi.org/10.1007/978-3-030-42634-7_289

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  • DOI: https://doi.org/10.1007/978-3-030-42634-7_289

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