Esotropia

What Is Esotropia?

Esotropia describes an inward turning of the eye and is the most common type of strabismus in infants. Young children with esotropia do not use their eyes together. In most cases, special glasses, bifocals, or early surgery to align the eyes is needed to allow for binocular vision development and to prevent permanent vision loss.

"Accommodative esotropia" is a common form of esotropia that is first seen in farsighted children, usually 1 - 4 years of age or older. When children are young, they can focus their eyes to adjust for farsightedness, a common condition in children. However, the focusing effort (accommodation) required to see clearly stimulates the eyes to converge, or cross.  

“Sensory esotropia” is the crossing of an eye with poor vision.

Symptoms

  • Decreased vision
  • Decreased depth perception
  • Crossing or inward deviation of the eyes, often intermittently at first.

The symptoms described above may not necessarily mean that your child has esotropia. However, if you observe one or more of these symptoms, contact your child's ophthalmologist for a complete exam.

Causes

Esotropia may be seen in children with very poor vision in one eye (sensory esotropia) or in association with certain genetic disorders that affect the eyes. It may also occur in association with a 6th cranial nerve palsy or previous eye muscle surgery for strabismus. But, most often, crossed eyes in childhood are either caused by idiopathic infantile esotropia (33 percent), with onset early within the first 6 - 8 months of life or accommodative esotropia (66 percent) first noted later, between 1 - 4 years of age, in association with increased levels of far-sightedness or hyperopia. For proper treatment, the exact cause of your child’s esotropia will need to be established after a complete eye exam by an ophthalmologist experienced with pediatric eye problems. So, if you, a relative, or your primary care practitioner suspect crossing of the eyes, either intermittently or constantly, which persists after six weeks of age, your child should be evaluated further by an ophthalmologist or orthoptist.

Risk Factors

  • Positive family history of strabismus (misaligned eyes), amblyopia, childhood cataract, or glaucoma
  • Some genetic disorders that affect the eyes
  • Pediatric cataracts or glaucoma
  • But most often there are no known risk factors in children with esotropia

Tests and Diagnosis

  • Visual acuity measurement in each eye and both eyes together (age appropriate)
  • Cycloplegic refraction (with dilating eye drops)
  • External or slit lamp exam
  • Fundus (retina) examination
  • Complete eye exam (age appropriate)

Treatment and Drugs

In accommodative esotropia, glasses reduce the focusing effort and convergence of the eyes and can straighten the eyes. Sometimes the addition of bifocals to the glasses is necessary for close work. Eye drops, ointment, or special lenses with prisms added can also be used to straighten the eyes. Eye drops called miotics (phopholine Iodide) or special lenses called prisms can also be used to straighten the eyes in some children depending on the cause and the size of the deviation.

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Reviewed by Monte A. Del Monte, M.D.