Table of ContentsView AllTable of ContentsSymptomsTypesCausesDiagnosisTreatmentComplicationsPrognosisFAQ
Table of ContentsView All
View All
Table of Contents
Symptoms
Types
Causes
Diagnosis
Treatment
Complications
Prognosis
FAQ
Esotropia is a disorder in which the eyes aren’t fully aligned and the affected eye(s) turn inward. It typically occurs in babies and children, but it can affect adults too. Esotropia is also associated with certain health conditions, includingpremature birth.
Esotropia in infants less than 20 weeks is common and usually resolves on its own.Treatment options for esotropia include the use of special glasses or eye patches. Eye muscle (strabismus) surgery may be considered when more conservative treatments fail to improve symptoms.
This article explains esotropia, its possible causes, and how it is diagnosed and treated. It also lists some of the health conditions that may increase the risk of esotropia in both children and adults.
The most common symptom of esotropia is crossed eyes, but it can also present with other symptoms, including:
There are several types of esotropia, and an eye care specialist will define the treatment based on certain characteristics:
In healthy eyes, muscles around each eye work together to control eye movement, allowing both eyes to focus on the same thing. In a person with esotropia, the muscles are not coordinated, and as a result, one or both eyes look inward and focus on different subjects.
Congenital Esotropia
Congenital esotropia, also known as infantile esotropia, develops within the first six months of life. Even though it is called congenital esotropia, this condition rarely presents at birth. The cause of congenital esotropia is unknown, but it is common and affects one in 50 newborns.
Transient misalignment of the eyes is common up to 3 months old, and should not be confused with infantile esotropia.
Acquired Esotropia
Acquired esotropia is commonly treated with eyeglasses, but some cases may not improve with corrective lenses.
Constant Esotropia
Constant esotropia occurs when the eye is turned inward all the time. Most cases of esotropia are constant, but some cases of accommodative esotropia are intermittent.
Intermittent Esotropia
The intermittency of accommodative esotropia is attributed to the fluctuating accommodative status of the patient as their eyes struggle to focus. Without treatment, intermittent esotropia is likely to turn into constant esotropia. The intermittent strabismus seen in infants is associated with normal development and typically goes away before 3 months of age.
Accommodative Esotropia
Accommodative esotropia can be classified into three types: refractive, non-refractive, and partially accommodative or decompensated. All three forms have an age of onset between 6 months and 7 years.It is frequently associated withamblyopia(lazy eye, or low vision due to abnormal visual development).
A child with accommodative esotropia will initially have alternating strabismus, which means they will occasionally use their right eye while the left eye is turned inward, and vice versa. However, many children very quickly learn to favor one eye over the other and will permanently switch off the image from the in-turned eye, causing that eye to become amblyopic.
If the angle of the esotropia is fully corrected with glasses, the strabismus is said to be a fully accommodative esotropia. If the angle of the strabismus is not fully corrected with glasses, it is called a partially accommodative esotropia. Cases where there is no change in the angle of strabismus with glasses are nonaccommodative esotropia.
Lazy Eye Exercises to Correct Amblyopia
Nonaccommodative Esotropia
Acquired nonaccommodative comitant esotropia refers to a group of conditions not associated with accommodating effort. It is not connected to any refractive problems but can be associated with an intracranial tumor or other central nervous system (CNS) lesions.
Nonaccommodative esotropia can’t be fixed with glasses. However, patients can often have this problem corrected with surgery.
Pseudoesotropia
Withpseudoesotropia, the alignment of the eyes is actually straight but they appear to be crossed. Pseudoesotropia occurs in children with a broad, flat bridge of the nose and/or pronounced epicanthic folds (the upper eyelid skin that covers the eye’s inner corner).
Pseudoesotropia is most common in infants with developing facial features and young children of Asian descent due to the anatomy of the Asian eye. Most children with pseudoesotropia outgrow this condition, and no treatment is needed.
Does Eye Strain Cause Esotropia?Eye strain may be a feature of some types, including accommodative esotropia. Another type, called acute acquired comitant esotropia (AACE), can occur more suddenly in children and adults. One small study found some cases of AACE emerged during the COVID-19 pandemic, as students did “near work” on smartphones and laptops during social distancing lockdowns.
Does Eye Strain Cause Esotropia?
Eye strain may be a feature of some types, including accommodative esotropia. Another type, called acute acquired comitant esotropia (AACE), can occur more suddenly in children and adults. One small study found some cases of AACE emerged during the COVID-19 pandemic, as students did “near work” on smartphones and laptops during social distancing lockdowns.
In Children
Esotropia may be seen in children with very poor vision in one eye or in association with certain genetic disorders that affect the eyes. Children can also develop strabismus after congenitalcataractsurgery.
In Adults
Some conditions that can cause esotropia in adults include:
The sudden appearance of strabismus, especially with double vision, in an older child or adult could indicate a more serious neurologic disorder. Call your healthcare provider immediately if this happens.
Tests and procedures used to diagnose strabismus include:
The main goals of treatment for esotropia include:
The choice of treatment depends on the severity of a person’s symptoms and whether there are any specific treatment goals they wish to achieve.
Glasses or Prism Lenses
Esotropia due to farsightedness is often resolved with glasses or contact lenses. In most people, corrective lenses will fix the over-focusing problem immediately. However, some people might still have esotropia while doing certain activities, such as reading, and an eye care specialist might prescribe bifocal lenses to treat it.
Certain types of esotropia, like partially accomodative esotropia, can be treated with prism lenses. Prism lenses have one side that is thicker than the other, and they change how the light enters the eye. It will reduce the effort the misaligned eye exerts when trying to focus on an object and improve the problem.
Vision Therapy
Vision therapy for esotropia aims to correct misalignment, encourage the eyes to work together, and improve control of their movements. Training sessions often include exercises aimed at improving:
An optometric vision therapy program consists of supervised in-office and at-home reinforcement exercises performed over weeks to months.It is used in conjunction with other treatments, such as eye patches and glasses.
Botox Injections
The injection of botulinum toxin (botox) is considered a safe and effective alternative to surgery for correcting esotropia in adults and young children.
A research review on the effectiveness of botox for correcting congenital esotropia in infants found that the treatment significantly improves eye alignment in 76% of cases.
Surgery
Strabismus surgery involves making an incision in theconjunctivato reach the eye muscles, isolating the problematic muscle, then loosening the muscle to relieve tension and re-set its resting position.No skin incisions are made during the procedure, which means the child will not have a visible scar.
Strabismus muscle surgery is typically done as an outpatient procedure, so the child can return home on the same day. After surgery, the white part of the child’s eye may be red, and the eyes may feel scratchy or sore with movement. The soreness should improve within a few days, although the redness can take weeks to months to disappear.
Some conditions are complications of esotropia and their symptoms may overlap:
Infantile esotropia can be easily treated with glasses or surgery, and children with this condition often grow up without vision problems.
When esotropia appears later in life, it can also be easily treated. However, it is essential to check if there are other underlying conditions that may be causing the misalignment.
Summary
Esotropia is common in infants less than four months of age, for whom it usually goes away on its own. Symptoms of esotropia may include eyes that look misaligned or that don’t move together, squinting or turning the head to see better, problems with depth perception, and double vision. Corrective glasses and eye patches are often effective for treating mild esotropia, whereas more severe esotropia may be treated with strabismus surgery, an outpatient procedure that does not leave a scar.
Frequently Asked Questions
Sometimes. Esotropia occurs when one or both eyes turn inward toward the nose. When amblyopia or lazy eye turns inward, it is esotropia. When it turns outward, it’s known as exotropia.
Both esotropia and esophoria involve a “cross-eyed” misalignment of the eye gaze. With esophoria, however, a person can more easily refocus the eye and control their vision when an eye drifts.
17 Sources
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