Esotropia

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What is esotropia?

Esotropia is one of the most common types of strabismus, a condition in which the eyes point in different directions. In esotropia, one or both eyes turn in toward the nose. It is sometimes called crossed eyes.

When a child's eyes are not aligned on the same target, the child's brain often ignores the image sent by one of the eyes to avoid confusion. That eye works less, and vision in that eye stops developing. When esotropia occurs in adults, they sometimes have double vision.

How does it occur?

Infantile esotropia usually develops by age 3 months. Its cause is not known. Without treatment, babies with esotropia will not develop the ability to use both eyes together.

Accommodative esotropia occurs in farsighted children. Normally, the lens in the eye must adjust to bring near objects into focus (called accommodation). In farsighted children, more effort is needed than normal. That effort causes the eyes to cross.

Some other causes of esotropia in children are:

• nerve problems
• eye socket or eye deformities
• eye injuries
• head injuries

These problems, as well as problems such as diabetes, thyroid disorders, myasthenia gravis, and stroke and other blood vessel problems, can cause esotropia in adults.

What are the symptoms?

• One or both eyes appear to be turned in.
• Older children and adults may have double vision.
• You may tilt or turn your head or squint one or both eyes.

How is it diagnosed?

Parents, caregivers, or family members usually notice that the eyes are not pointed in the same direction. An ophthalmologist (medical eye doctor) will do vision tests and check the ability to follow objects with each eye. Looking at old photographs is sometimes helpful to determine how long the eyes have been crossed.

How is it treated?

Infantile esotropia usually requires surgery. If one eye is weaker than the other (called amblyopia), the stronger eye may be patched to force the brain to use the weaker eye. Surgery on the muscles around one or both eyes can be done to tighten, loosen, or reposition these muscles. About 2 out of 10 patients require more surgery later in life. Children with esotropia should have frequent eye exams throughout childhood.

Accommodative esotropia is usually treated with glasses. When the farsightedness is corrected with glasses, the child will not need to use as much focusing power to see close objects clearly. The eyes stay straight while the glasses are worn. The strength of the lenses may need to be changed as the child grows. Sometimes bifocals are needed.

During surgery the doctor will tighten or loosen one or more eye muscles to change the direction that the eyes point. Surgery to straighten the eyes does not correct vision in the eye. It does improve the person's appearance and can help the eyes work together.

In rare cases, the eye care provider may inject a drug called botulinum into the eye muscle instead of doing surgery. This drug temporarily paralyzes the muscle getting the shot. It may help to straighten the eye. More than 1 shot is often needed because the effect of the drug lasts for just about 6 to 12 weeks.

Strabismus surgery is not cosmetic surgery. Having eyes that are not aligned normally can interfere with the ability to communicate with others through eye contact. Most insurance plans reimburse for this surgery for children and adults who do not have both eyes working together (binocular vision).

Reviewed for medical accuracy by faculty at the Wilmer Eye Institute at Johns Hopkins. Web site: http://www.hopkinsmedicine.org/wilmer/

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