A 3-year-old boy attends your practice. He has no symptoms, but his mother thinks that his right eye turns in when he is tired or when he has been drawing. What are the 3 most likely diagnoses? What are the cover test findings (with and without single vision glasses) that you would expect to find in each case?

Three likely diagnoses:

1) Fully accommodative esotropia.

2) Partially accommodative esotropia.

3) Convergence excess esotropia.

Cover test findings:

1) Without glasses larger R esotropia at near than at distance. With glasses no R esotropia at distance no R esotropia at near but maybe an esophoria at near.

2) Without glasses larger R esotropia at near than at distance. With glasses very slight R esotropia at distance with greater R esotropia at near but maybe an esophoria at near.

3) Large esotropia at near with and without glasses but larger without. Orthophoria or esophoria at distance with and without glasses.

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