Longer term management
If adequate recovery has not occurred after the 6-month period (during which observation, prism management, occlusion, or botulinum toxin may be considered), surgical treatment is often recommended.If the residual esotropia is small, or if the patient is unfit or unwilling to have surgery, prisms can be incorporated into their glasses to provide more permanent symptom relief. When the deviation is too large for prismatic correction to be effective, permanent occlusion may be the only option for those unfit or unwilling to have surgery. Surgery
The procedure chosen will depend upon the degree to which any function remains in the affected lateral rectus. Where there is complete paralysis, the preferred option is to perform vertical muscle transposition procedures such as Jensens, Hummelheims or whole muscle transposition, with the aim of using the functioning inferior and superior recti to gain some degree of abduction. An alternative approach is to operate on both the lateral and medial recti of the affected eye, with the aim of stabilising it at the midline, thus giving single vision straight ahead but potentially diplopia on both far left and right gaze. This procedure is often most appropriate for those with total paralysis who, because of other health problems, are at increased risk of the anterior segment ischaemia associated with complex multi-muscle transposition procedures. Where some function remains in the affected eye, the preferred procedure depends upon the degree of development of muscle sequelae.
Digitate or Filiform warts are warts that often appear on the eyelids, lips, face, or neck. The warts tend to grow directly outwards from the skin. They have a spiky, thread-like or finger-like appearance. They sometimes look and feel like tiny brushes, making them especially uncomfortable for the patient.As with other wart types, a number of treatments are available, including laser therapy, cryotherapy, salicylic acid, and other topical treatments. == References ==