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How is esotropia in a 67-year-old treated which just occurred one week ago?
It is probable that this represents a 6th nerve palsy, likely from a small stroke to the nerve. It is very likely that the patient has stroke risk factors such as hypertension, high cholesterol, diabetes. It is very important to see an ophthalmologist immediately for diagnosis. An urgent MRI scan and blood work may be indicated depending on the patient's risk factors and other symptoms.
If the situation indeed is a 6th nerve palsy from a small stroke, the treatment is observation typically, as small strokes in patients this age often resolve without surgery or any treatment.
Prism glasses can be given to help the patient see single, but if the problem is improving prism glasses would have to be changed frequently, and this would be expensive.
A patch can be used to cover one eye or one spectacle lens to prevent double vision, waiting for the situation to improve. Botulinum toxin type A is occasionally injected into the middle pulling muscle of the involved eye. That can be used if the palsy does not start to improve within a few weeks or months. This can help straighten the eye by weakening the middle pulling muscle and it can be repeated.
Lastly if the palsy does not resolve in nine months, and the crossing is large in amount, eye muscle surgery can be offered. Prism glasses can also be used if crossing of the eye is of a small amount and is not improving.
Answered by: Jane C. Edmond, MD
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