Types and Treatment of Esotropia | Ophthalmology


What is esotropia?

Esotropia is a strabismus condition that develops inside the eye (towards the nose). This condition can be intermittent (not all the time) or constantly apparent. Deviation or rolling of the eyes can occur when (looking at) distant, near, or near objects. This is also known as cross-eyed.

Types of esotropia

Esotropia can be classified according to its frequency of frequency, the age of the developing person, and the ocular focus.

The different classifications include:

Accommodative esotropia: It is characterized by crossing the eyes, which occurs when the eyes are desperately trying to focus to see objects clearly. This attempt to concentrate is called “accommodation.” People with accommodative esotropia, also known as refractive esotropia, are often myopic.

People can manage this by wearing medicine glasses or contact lenses. If this fails, they may need surgery.

Non-accommodative esotropia: It is often connected with an underlying disorder. Early surgical repair is more useful for children with this condition than vision correction with glasses.

Infantile esotropia: The infantile form of the condition begins in the first year of life. Babies with this condition cannot use both eyes together. If one of the eyes turns inward than the other, the child is at increased risk for amblyopia, also known as lazy eye.

Infantile esotropia is usually treated with surgery, glasses, or sometimes Botox injections. Correction of esotropia before age 2 in children is very successful, and few children experience visual problems as they grow older.

Other eye problems associated with infantile isotropy include eye fatigue, shortness of breath, and nystagmus, which is the movement of the eyes.

Mechanical esotropia: It is caused by difficulty with the intraocular muscles. The muscles of the eye may be restricted or strained by disease (such as thyroid myopathy, for example), or they may be physically obstructed as a result of a blowout fracture (a blowout fracture is a fracture of the walls of the eye socket, in terms of the eye sockets of the skull). This can be seen in children with Duane syndrome, a disorder of the eye muscles that can block the external movement of the eye (towards the ear).

Sensory esotropia: A person with this condition has reduced visual acuity in one eye, which interferes or interferes with normal binocular vision (binocular vision is the coordination of both eyes, so the unique and slightly different images visible for each eye are seen as a single image). This occurs most often in children younger than 5 or 6 years old.

Causes of esotropia

The cause of the esotropia depends on when it first occurs. In adults, the sudden onset of esotropia is a sign of a more serious condition. In infants and young children, cross-eyed is usually a sign of abnormal development of the developing binocular system in the brain. However, there are other reasons as well.

Under 4-5 months of age, intermittent crossovers are common and a signal for learning to use the eyes as a system. Some children and species may have false strabismus. This is a condition in which the bridge of the nose is not fully developed or flattened more than normal. These babies have “epicanthal folds” that make the eye look a bit dizzy. As the baby develops, this appearance usually disappears and her eyes appear normal.

Risk factors

Risk factors for esotropia are:

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

Symptoms of esotropia

The most notable sign of esotropia is the crossing of one or both eyes, usually intermittently at first.

Sometimes there are no symptoms of esotropia. In children, the brain often suppresses an image so that they do not experience a double image.

Double vision is a very common symptom in early adult cross-eyed. These patients may also experience blurred vision or visual field.

Other symptoms include difficulty understanding in depth.

Diagnosis of esotropia

Infants and children with suspected esotropia are usually evaluated by a pediatric ophthalmologist or optometrist, who reviews the child’s medical and family history and then performs a test to confirm the child’s visual acuity. Evaluates the general health of the eyes and their refractive state (that is if the child has farsightedness, myopia, or astigmatism). The eyes are separated with eye drops to determine the level of foresight.

The ophthalmologist or optometrist pays close attention to whether the sharpness in both eyes is equal or whether one eye is stronger than the other. If one eye has a strong preference over the other, amblyopia can occur. Amblyopia occurs when one eye cannot adequately communicate visual images to the brain and is best treated at a young age. Sometimes it can be treated with strong eye contact, but in some cases, more aggressive treatment methods are required. If eye misalignment is detected, the level of misalignment is measured so that the child can fit the appropriate glasses.

Treatment for esotropia

Treatment goals include correcting refractive error, treating double vision and/or amblyopia (“lazy eye”), restoring proper eye alignment, and, if necessary, helping both eyes work together to focus.

People with cross-eyed, especially children, can wear prescription glasses to help with misalignment. In some cases, you may need glasses for forecasting.

Surgery: This is not performed by an optometrist, but by an ophthalmologist. This is considered a last resort and is not suitable for all types of esotropia. Eye surgery can correct the misalignment of the eye and improve visual acuity. After the age of 14, this surgery is purely cosmetic.

In some cases, botulinum toxin (Botox) injections may be used. Helps to reduce esotropia in small amounts. In turn, your vision lines up. Botox should not be used as an alternative treatment for esotropia.

Some types of eye exercises can also help. They are often called vision therapy. For example, your doctor may recommend placing a patch on the unaffected eye. It forces you to use the ill-designed eye, which strengthens it and helps improve vision. Eye exercises improve the alignment of the muscles around the eye.


Here are some problems that babies and children can experience if they have cross-eyed is neglected:

  • Inability to process three-dimensional vision
  • Loss of consciousness of the whole picture
  • Development of amblyopia – a condition in which the child has a clear loss of vision in the transverse eye.

The following are some of the problems older children and adults can face if isotropy is not diagnosed and/or treated:

  • Double observation (diplopia)
  • Trouble seeing deeper and clearer images
  • Decreased binocular vision

Departments to consult for this condition

  • Department of Ophthalmology
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