IEMT for a client with bilateral esotropia



What is the effect of IEMT upon clients who have ocular impairments? Since IEMT works by directing eye movements it is reasonable to ask whether IEMT will be effective in clients with ocular motility impairment.

Practitioners will be aware that ocular disease will render IEMT an unsuitable therapy for a number of clients:

"Ocular Disease: Until there is sufficient medical evidence to suggest otherwise, eye movement work should not be be used with any individual who has any active or current ocular disease process. There are no exceptions to this. Such conditions include conjunctivitis, glaucoma, history of detached retina and recent trauma such as "a black eye." Problems such as a "lazy eye" and poor focal vision are not necessarily a contra-indication unless there is an active and concurrent disease process underlying it.” The Association for IEMT Practitioners Handbook.

For an article on “Origins of Strabismus and loss of binocular vision” please click link (opens on new window).

Click this link for an article on esotropia: https://www.medicalnewstoday.com/articles/319948.php#complications

Male 50. Strabismus. Monocular vision. No smooth pursuit eye movement.

Strabismus is a common problem of ocular misalignment. Most often seen in children and common at birth. Strabismus is observed when both eyes do not face the same direction along vertical or horizontal axes. Strabismus can result in double vision and impaired depth perception.

In adulthood, strabismus can occur as a result of brain injury, stroke, Grave’s disease, and Guillain-Barre syndrome among other causes.

In children, the condition is often rectified by the uses of exercise, corrective lenses or surgery. This client has was born with a variation of strabismus in which both eyes are turned inwards known as bilateral esotropia. Attempts were made whilst an infant to correct the sight but these failed. Aged 8 the client was offered a third surgery to realign the eyes, as the previous surgeries has provided limited success. This was declined because of a 50% chance that the surgery would cause strabismus in the opposite direction.

As a result of the esotropia, the client had developed monocular vision. Usually, this is understood having only one eye, or vision in only one eye. In this client both eyes function, though with a degree of astigmatism, hypermetropia and presbyopia, but they function separately.

The client can see only out of one eye at a time. This is alternating esotropia.

When working with an a client with fairly normal ocular motility it is clear to the IEMT practitioner that the client is fixated on the fingers. In alternating esotropia, it is not always very easy for the practitioner to know which eye is fixating on the fingers during the movements. In fact, some clients will switch between one eye and the other as the fingers of the practitioner move out of the area of monocular vision of one eye, into the binocular field of vision and then back into the monocular field of vision of the other eye and again in reverse.

This can, and in the case of this client did, result in a lack of smooth pursuit eye movements. Indeed it can appear that the client can only perform anticipatory saccadic movements - the eyes moving to the end of the axis upon which the practitioner’s finger is travelling before the finger reaches the end of the movement.

Whilst asking the client to close one eye and follow the finger would have allowed the practitioner to know which eye was fixated it would only have reduced the client’s field of vision. Instead, the practitioner used a motion created by the flexion and extension of the index and middle fingers (vertical waggling) that allowed the client to fixate more easily upon the fingers and track the movement.

Close observation of the client was required to see the point at which one eye took over fixation and tracking from the other. To see this more clearly sometimes required the reversal of the movement of the fingers along the axes (going back) to allow peripheral vision in the non-fixated eye to detect the movements in engage pursuit.

The result of the therapy was entirely satisfactory for the client achieving both the reprocessing of a troublesome recurrent memory of colleague behaving obnoxiously and a reduction in the associated emotion, along with a reduction of stress and anxiety in response to anticipated encounters with the same colleague.

Gavin Bowtell, Dip.Hyp. HPD, BWRT(adv) is an IEMT practitioner and hypnotherapist living and working in Chigwell, Essex. He is noted by clients and colleagues for his acute observation and incisive listening skills which focus in quickly on the nub of the problem. He is the author of popular hypnotic scripts and co-author of a therapists’ manual for working with LGBT+ clients. He has advanced qualifications in BWRT, archetypal parts work, and a specialist diploma in psychosexual disorders. https://www.essexmindcoach.co.uk