Cortical binocularity and monocular optokinetic asymmetry in early-onset esotropia.

Purpose: To investigate the correlation between directional asymmetry in ocular responses to monocularly viewed optokinetic stimuli (monocular optokinetic nystagmus, MOKN) and sensory fusion in infants and toddlers with early-onset esotropia.

Methods: Subjects were 14 infants and toddlers with early-onset esotropia (7-26 months old; median, 10 months), and 16 with no esotropia (6-22 months; median, 11 months) who provided control data. Monocular optokinetic nystagmus in response to a 30 degrees/sec square-wave grating (0.25 cycles/degree) was measured by electro-oculogram. Sensory fusion was assessed with visual evoked potentials (VEPs) to random-dot correlograms after correction of the strabismus angle with Fresnel prisms.

Results: All subjects with early-onset esotropia had MOKN with a faster slow-phase component for temporal-to-nasalward (TN) than nasal-to-temporalward (NT) motion. Ninety-three percent of subjects had MOKN asymmetry higher than the 95th percentile of the control group. Of subjects who cooperated with VEP fusion testing, 5 subjects with early-onset esotropia (45%) and 11 control subjects (92%) showed evidence of sensory fusion.

Conclusions: Symmetrical MOKN did not develop in infants and toddlers with early-onset esotropia. This deficit existed in most infants who showed sensory- cortical fusion. These results are consistent with the belief that optokinetic nystagmus asymmetry may not be associated with a deficit in the cortical fusion facility, but rather with deficits in binocular pathways projecting to MOKN control centers. These deficits may be associated with abnormal processing subsequent to sensory fusion or with abnormal processing in motion pathways, which run parallel to sensory fusion pathways.