Esotropia

What is esotropia?

Esotropia is an eye condition in which one or both of your eyes turn inward. It’s a type of strabismus, which means that your eyes don’t line up or align correctly. Some people refer to esotropia as being “cross-eyed.” Esotropia can be monocular (involves one eye) or binocular (involves both eyes).

The muscles and nerves that control your eyes usually allow both of your eyes to work together. In esotropia, this control isn’t as coordinated as it should be. Esotropia is the opposite of exotropia, the turning outward of your eyes.

Although esotropia can happen at any age, it commonly occurs in babies and children. It can affect not only your child’s vision but also their social and emotional development. Many children experience reduced self-esteem due to the appearance of the condition. That’s why it’s important to seek diagnosis and treatment as soon as you notice symptoms.

Types of esotropia

There are many different kinds of esotropia, including:

• Intermittent esotropia: Intermittent esotropia comes and goes. It isn’t present all the time.
• Constant esotropia: This type of esotropia is constant. It’s present all the time.
• Infantile or congenital esotropia: Infantile or congenital esotropia is present at birth or develops in early infancy.
• Alternating esotropia: This type of esotropia occurs in both eyes but at different times.
• Accommodative esotropia: Healthcare providers can treat this type of esotropia with glasses or contact lenses.
• Nonaccommodative esotropia: Your provider can’t treat this type of esotropia with corrective lenses. You may need surgery.
• Pseudoesotropia: This is a condition that appears to be esotropia due to a flat bridge of your baby’s nose and extra skin covering the inner corners of their eyes (epicanthal folds). This form of esotropia doesn’t need treatment and children grow out of it with age.

What are the signs and symptoms of esotropia?

The main symptom of esotropia is that one or both of your eyes turn inward toward your nose. You may not be able to see it yourself if you have it. Other symptoms may include:

• Eyes that don’t move together.
• Squinting, blinking and turning your head in order to see better. This can lead to eye strain.
• Problems with depth perception.
• Diplopia (double vision).
• Amblyopia (decreased vision in one eye).

What causes esotropia?

Esotropia is caused by a lack of coordination of your eye muscles. Usually, your eye muscles work together, as a binocular system (“seeing with two eyes”). You can tell how close you are to something. It’s important for eyes to work together while you’re riding a bicycle, driving a car or reading.

Young children with esotropia are typically farsighted, meaning they can see things that are farther away more clearly than things that are closer. Sometimes, esotropia is a sign that you need glasses to correct farsightedness.

Esotropia is sometimes genetic. You may have other biological family members with misaligned eyes.

Esotropia can be a sign of other conditions, including:

• A problem inside one or both eyes, like a cataract, retina or optic nerve problem.
• An issue that affects your brain, like increased intracranial pressure or a brain tumor.
• Neurological conditions, like stroke or nerve damage from diabetes.
• Eye injury.
• Thyroid conditions.

What are the risk factors for esotropia?

Esotropia has many potential risk factors, including:

• Preterm birth.
• Biological family history of strabismus.
• Substance and alcohol use during pregnancy.
• Genetic variations.
• Neurologic disorders.
• High farsightedness.
• Other health conditions, including hyperthyroidism and diabetes.

What are the complications of esotropia?

Esotropia makes it hard for your eyes to work together, which can lead to:

• Double vision.
• Problems with peripheral vision.
• Loss of 3-D vision and binocular vision.
• Blurry vision.
• Amblyopia.

In addition, people are likely to experience a loss of self-confidence due to cosmetic concerns, which can lead to social anxiety and performance issues in school and other activities.

How is esotropia diagnosed?

Your healthcare provider may refer you to an ophthalmologist or optometrist. The provider will ask about your family and medical history and perform an eye examination. They may perform the following tests:

• Visual acuity test.
• Refraction test, which tests your eyes with corrective lenses to measure how they focus light.
• Alignment and focus tests.
• Pupil dilation (widening) test, which determines the health of your internal eye structures.

What medications or therapies treat esotropia?

Some cases of esotropia may get better on their own. For those that don’t, your eye care specialist may suggest one of these treatments or a combination of treatments, including:

• Glasses or contact lenses.
• Amblyopia treatment (patching the stronger eye or using a dilating eye drop to blur the vision of the stronger eye).
• Prisms.
• Injections of botulinum toxin (Botox®).
• Strabismus surgery.

If you have esotropia as a symptom of some other condition, your healthcare provider will treat that condition. Esotropia usually improves when you manage whatever’s causing it.

How can I prevent esotropia?

You can’t prevent esotropia entirely, but you can help your child manage it by taking them for regular eye exams as soon as you notice any changes in their eyes or vision.

What is the outlook (prognosis) for someone with esotropia?

If you have treatment for esotropia, like getting glasses or contacts or having surgery, your prognosis (outlook) is good. It’s important to follow your treatment plan carefully and see your provider for regular follow-up appointments.

When should my child see their healthcare provider about esotropia?

If your child’s eyes are bothering them at any point — you notice them squinting a lot or moving objects around to try to focus better — call their healthcare provider. This is also true for you.

If your eyes, or your child’s eyes, change suddenly and look different, call your provider, especially if the changes happen after some type of injury. After an injury, get help right away.

What questions should I ask my child’s healthcare provider?

Questions you may want to ask your child’s provider include:

• What type of esotropia does my child have?
• What treatment options do you recommend?
• Does my child need surgery?
• How can I prevent esotropia from returning?