Concomitant strabismus: binocular visual axis separation, no temperament lesions in extraocular muscles, innervation and muscle stop, no obstacle to eye movement, change the gaze direction, the strabismus angle remains unchanged, the difference between the first strabismus angle and the second strabismus angle is less than 5 △, and there is no diplopia and compensatory head position. Some patients with concomitant strabismus have family genetic tendency. The horizontal direction of concomitant strabismus is divided into esotropia and exotropia. The appearance of esotropia is that one or both eyes are inclined to the root of the nose, which makes the black eyes of both eyes converge. Therefore, it is commonly known as "cockfighting eye" and "eye to eye".

There are two types of congenital esotropia: congenital esotropia and congenital esotropia.

Congenital esotropia: it usually occurs within 6 months after birth, and the degree of esotropia exceeds 25 ° (45 △).

Clinical manifestations: the visual acuity of both eyes is roughly equal and normal. The first oblique angle is similar to the second oblique angle, forming an alternating inward oblique, that is, right eye fixation and left eye deviation, left eye fixation and right eye deviation, and the degree of deviation is similar. The far and near oblique angles are similar, which has no obvious relationship with regulation, and the AC / A is normal. The patient's refractive error is lower than + 2.00D and astigmatism is not greater than 1.00D.

Treatment principle: it is generally believed that congenital esotropia is caused by the lack of collective excitation inhibition in the cerebral cortex. In order to enable children to obtain binocular development, surgery should be performed before the age of 2. Correction of ametropia is not helpful for eye position correction.

Accommodative esotropia: accommodative esotropia is caused by the excessive use of accommodation by the human eye. It occurs in 1 ~ 4 years old and is divided into refractive esotropia and hyperintense esotropia.

Refractive esotropia: the degree of hyperopia is greater than + 4.00d, the degree of strabismus is 20 △ ~ 30 △, the distant and near oblique angles are similar, and the AC / A is normal. Because patients have high hyperopia ametropia, they need to adjust whether they look far or near. Every 1.00d adjustment will be accompanied by a certain amount of regulatory set. Whether esotropia occurs depends on the child's binocular fusion image dispersion reserve capacity. If there is not enough fusion image dispersion to offset the regulatory set at the same time, esotropia will occur.

Figure 1

Hyperaggregative esotropia: ametropia is lower than + 2.00D, AC / A is greater than 5 △, there is no esotropia or mild esotropia when looking far, and excessive aggregation is induced due to excessive accommodative aggregation when looking close, resulting in 20 △ ~ 30 △ esotropia.

Treatment principle of accommodative esotropia: first, cycloplegia optometry, hyperopia foot correction, myopia undercorrection, and astigmatism are fully corrected. Refractive esotropia disappears after wearing glasses and can be corrected after 3 ~ 6 months (as shown in Figure 1). Multifocal glasses can be considered for collective hyperintense esotropia. The near use additional luminosity is given + 2.50D ~ + 3.00D before the age of 5, gradually decreases from the age of 5 to 10, and is removed after the age of 10 (as shown in Figure 2).

Figure 2

Common exotropia: divided into intermittent exotropia and constant exotropia.

Intermittent exotropia: it accounts for 80% of exotropia. Due to the lack of collective excitement and low fusion ability of cerebral cortex, optic axis separation occurs when fatigue or inattention. In the de masking experiment, it is seen that the covered eye cannot recover the fixation position, and there is a trend towards constant exotropia with age.

Clinical manifestations: this disease is related to heredity, and has no significant correlation with myopia. Intermittent exotropia can be divided into several types. The collection is insufficient. The near oblique angle is greater than the far oblique angle. The AC / A is too low. It is more common in adults and develops rapidly. It is suitable for early surgery. Spread too strong, far oblique angle is greater than near oblique angle, AC / A is too high, which is common in children. For the basic type, the far oblique viewing angle is similar to the near oblique viewing angle, and the AC / A is normal.

Treatment principles: cycloplegia optometry, undercorrection of hyperopia, foot correction of myopia, and attention to astigmatism correction. Using the bottom out prism for orthostatic vision training can get a good effect of restoring binocular vision. If it is greater than 15 △ it should be operated early.

Constant exotropia: it is related to ametropia. Because myopia does not use or uses less adjustment to see near, it leads to collective disuse, and gradually presents exotropia when looking far; Hyperopia, astigmatism or anisometropia often occur disuse amblyopia due to monocular visual impairment, and the amblyopia stays in the external oblique rest position.

Treatment principle: collective training can be carried out for constant exotropia caused by myopia, and early operation is suitable for other types.