Divergence Insufficiency Esotropia: Surgical Treatment

Divergence insufficiency esotropia, or acquired comitant esotropia that is at least 10Δ larger at distance than at near, is most often seen in older adults, and may also be known as "age-related distance esotropia." Surgical treatment is often indicated for patients who do not tolerate prism therapy, or for those with large angles of esotropia. Surgical treatments have evolved with our understanding of the disease-state. Currently, accepted treatments include lateral rectus resection and medial rectus recession. These surgeries can be performed unilaterally or bilaterally. New surgical techniques such as lateral rectus equatorial myopexy are under investigation and may hold promise as future therapies.