Esotropia

What is esotropia?

Esotropia is an eye condition that refers to either one or both of your eyes pointing inward. Esotropia is a type of strabismus, which means that your eyes don’t line up correctly. You may hear people talking about “crossed eyes” instead of esotropia. Esotropia can be monocular (involves one eye) or binocular (involves both eyes).

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

What is the difference between esotropia and exotropia?

Both conditions refer to a misalignment of your eyes. The difference is in which way they deviate. In esotropia, one or both of your eyes point inward toward your nose. In exotropia, one or both eyes point outward toward your ears.

In esotropia, amblyopia (“lazy eye”) is common and may be severe. Amblyopia doesn’t happen as often with exotropia.

What is the difference between esotropia and esophoria?

Both conditions refer to your eyes pointing inward toward your nose. Usually, if you have esophoria, your eyes work together well, but the crossing is only evident when you close or cover one eye.

Is esotropia genetic?

Strabismus can run in families. However, if someone in your family has esotropia, that doesn’t mean that you or your kids will have it. You or your child may not have the same type of strabismus as other people in your family.

How common is esotropia?

About 13 million people in the U.S. have strabismus. Esotropia is a common form of strabismus and happens in about 1% to 3% of the population.

Are there different types of esotropia?

There are different ways of classifying esotropia, including:

Esotropia classification by age

In this case, the breakdown is between congenital (infantile) esotropia, which is present at birth or by six months of age, and acquired esotropia, which happens after birth.

Esotropia classification by how often it happens

In this case, you would either have intermittent esotropia, which isn’t permanent, and constant esotropia, which is present all the time.

Up to about six months, it’s normal for a child to have some intermittent esotropia, or some occasional inward turning of their eye.

Esotropia classification by how it’s treated (with or without glasses)

Healthcare providers can treat accommodative esotropia with glasses or contact lenses. Accommodative esotropia happens when you strain too hard to be able to focus.

If glasses can’t fully correct your esotropia, your healthcare provider may say that you have partially accommodative esotropia. They may recommend strabismus surgery to correct the crossing that’s not controlled by glasses.

Your healthcare provider won’t be able to correct nonaccommodative esotropia with glasses. They may suggest surgery.

Esotropia that isn’t really esotropia (pseudoesotropia)

Pseudoesotropia (false esotropia) is a condition that appears to be esotropia but isn’t. Your baby may look like it has inward-looking eyes but the effect is caused by a combination of a flat bridge of their nose and extra skin covering the inner corners of their eyes (epicanthal folds). This appearance will improve as your child grows older.

What are the signs and symptoms of esotropia?

The main symptom of esotropia is that one or both of your eyes point inward toward your nose. You may not be able to see it yourself if you have it. Other symptoms 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 or driving a car or reading.

People 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 family members with misaligned eyes.

Esotropia can be a sign of other conditions, including:

• A problem inside one or both eyes, such as a cataract, retina or optic nerve problem.
• An issue in your brain, such as elevated pressure or a brain tumor.
• Neurological conditions, such as stroke and nerve damage from diabetes.
• Eye injury.
• Thyroid conditions.

Is esotropia contagious?

No, esotropia isn’t contagious. You can’t give it to someone. You can’t get it from anyone else.

How is esotropia diagnosed?

Your healthcare provider will ask for a family and medical history and will do a physical examination. The exam will cover how your eyes move and focus. Testing may include:

• Visual acuity (reading letters off an eye chart, or examining young children’s visual behavior).
• Refraction (checking your eyes with a series of corrective lenses to measure how they focus light). Children don’t have to be able to give verbal feedback for these tests.
• Tests of alignment and focus.
• Examination after dilation (widening) of your pupils to determine the health of internal eye structures.

What medications or therapies treat esotropia?

Some cases of esotropia may resolve on their own. Your healthcare provider 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 drop to blur the vision of the stronger eye).
• Prisms.
• Injections of botulinum toxin (often called by the brand name Botox®).
• Surgery.

If you have esotropia as a symptom of some other condition, your healthcare provider will treat you for that condition so esotropia improves.

How can I prevent esotropia?

You can’t prevent esotropia. You can reduce the complications from esotropia by making sure your children have an eye exam if you see their eye crossing. Like any other condition, it’s best to diagnose esotropia early.

What can I expect if I have esotropia?

If you have treatment for esotropia, such as getting glasses or contacts or having surgery, your prognosis (outlook) is good.

Can esotropia cause blindness?

It’s true that untreated esotropia can lead to loss of vision, called amblyopia.

When should I see a healthcare provider about esotropia?

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

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

A note from Cleveland Clinic

Esotropia is a form of eye misalignment (strabismus) that affects 1% to 3% of the U.S. population. You may notice it in your new infant if one or both of their eyes turn inward. Intermittent esotropia may resolve by itself, but if their eyes cross all the time, you should ask for an eye examination. Esotropia is treatable. If you notice misalignment that happens suddenly, in either an adult or a child, contact your healthcare provider. Esotropia can be a sign of some other condition.