Neurology of Infantile Esotropia

Dr Michael Brodsky

Meeting:  2017 RANZCO


Date:      -

Session Title: Plenary Session

Session Time:      -

Speakers and Topics: Infantile esotropia is generated by prenuclear visual pathways that increase esotonus and gradually drive the eyes into a convergent position. Contrary to the prevailing notion that infantile esotropia re?ects a primary disturbance within the visual cortex, accumulating evidence suggests that infantile esotropia is generated by lower subcortical centers that subserve nasalward optokinesis. These phylogenetically older visuo-vestibular pathways include the nucleus of the optic tract, accessory optic system, inferior olive, cerebellar ?occulus, and vestibular nucleus. In humans, the subcortical visual system is normally turned off after the ftrst few months of infancy but retains its function in children who develop infantile esotropia. Mutations that prolong subcortical neuroplasticity may therefore lead to a persistent simultaneous nasalward optokinetic imbalance in both eyes to generate infantile esotropia.Deftcits in cortical motion processing (i.e. monocular nasotemporal optokinetic asymmetry) are likely the effect, rather than the cause, of infantile esotropia