intermittent strabismus in a 1.5 year child

Hi, Our son has been diagnosed with an intermittent infantile esotropia of about 30-35PD. He's only squinting when looking at distances from 20-30 inches to 8-10 feet. When he looks far, there is usually no noticeable squint. Also, the angle of the suint is not constant - sometimes little, sometimes full. We are being offered surgery at this time and there apprears to be a lot of research showing benefits of early surgery. However, it seems most of this research is done on patients with a constant squint - hence my question: in the case of an intermittent strabismus, is early surgery still the best answer or is there some binocularity left in the visual system (possibly) and the child might benefit from things like Vision Therapy? Thank you all for your time. Michael

[John C Hagan III, MD, FACS, FAAO]

Visual therapy is not helpful. If he was not born with this and it came on between ages 2 and 5 the most common cause is accommodative esophtrophia and the treatment is bifocals.

My suggestion would be to get a second opinion from a pediatric ophthalmoologist.

JCH MD