Dr. Burke is one of Cincinnati’s most trusted resources concerning Esotropia.

What are the common types of esotropia?

There are four types of esotropia. The four types are infantile or congenital esotropia, accommodative esotropia, late onset non-accommodative esotropia, and a combination of accommodative and non-accommodative causes referred to as mixed mechanism esotropia.

What is infantile esotropia?

Congenital or infantile esotropia describes a constantly crossed or turned in eye in an infant less than 12 months old. This type of esotropia occurs in up to 1% of infants. In almost all cases of infantile esotropia, early surgical treatment is necessary to realign their eyes.

If you suspect your child has esotropia, what should you do?

Besides parents, a pediatrician or family doctor is often the first person to suspect strabismus. Any baby whose eyes do not appear straight by the age of 3-4 months should have a thorough pediatric ophthalmologic exam. Strabismus that is not treated early in the child’s life may cause amblyopia (poor visual development in one or both eyes). As soon as a child is suspected of having a misaligned eye (Strabismus), a complete exam with a Pediatric Ophthalmologist is necessary to determine if there is an eye problem.

If I just wait, will my child’s misaligned eyes get better by themselves?

No. Children do not outgrow strabismus. Treatment for strabismus is required. These treatments may include glasses, amblyopic therapy (patching or eye drops), and eye muscle surgery.

What is Strabismus?

Strabismus is the encyclopedic word that describes a problem in which the eyes are not properly aligned with each other. The eyes are not properly aligned and do not focus on one object together at the same time. An eye may be misaligned all of the time (constant) or only some of the time (intermittent). The common types of horizontal strabismus are esotropia and exotropia. When the eyes are vertically misaligned, this is referred to as hypertropia.

What are the risk factors for Strabismus?

One of the highest risk factors for strabismus is having a family history of strabismus. Significant prematurity, cerebral palsy and other neurological problems, and genetic disorders also increase the risk of eye misalignment.

How is strabismus diagnosed?

Pediatric ophthalmologists are experts in the examination techniques to confirm the diagnosis of strabismus. Most patients are referred to pediatric ophthalmologists by pediatricians, family doctors, and other ophthalmologists and optometrists because on their examinations an eye misalignment problem is suspected.

Who specializes in the treatment of Strabismus?

The American Association for Pediatric Ophthalmology and Strabismus is an organization of pediatric ophthalmologists dedicated to the prevention and treatment of eye problems in children and the treatment of strabismus in people of all ages.

What is pseudo-esotropia?

Pseudo-esotropia is the illusion that the eyes are crossed where indeed they are straight and properly aligned. The eyes of infant often seem to be crossed. Infants and young children often have a wide and flat nasal bridge causing the folds of skin at the inner corners of the eyelids to partially cover the inner corners of each eye giving the illusion that the eyes are crossed. This is particularly noticeable when the child is looking to either side. Photographs often catch a child in these positions causing many parents to suspect the child may have crossed eyes. This illusion of strabismus improves as the child’s face grows and, in most children, is no longer noticeable by the age of 5.

What is accommodative esotropia?

Accommodative esotropia is a common form of crossed eyes occurring in up to 2% of children and typically developing after 12 months and before 5 years old. Accommodation refers to the powerful force that allows the eye to focus. When we accommodate on a close target, this powerful focusing force also activates convergence, or the turning inward of the eyes to look at or be aligned upon nearby objects. These two activities (focusing and turning the eyes inward) are both controlled by the same nerve and happen at the same time. This whole process is called accommodative convergence. Most children with accommodative esotropia are farsighted. Farsighted children have to use their focusing mechanism inside their eyes (accommodation) more powerfully than do most children. Because the same nerve controls focusing and turning the eye inward, the farsighted child who is working very hard to focus may cross (over-converge) the eyes at the same time. This is called accommodative esotropia or may also be described as focusing-related-crossing.

How is accommodative esotropia treated?

Most children with focusing-related-crossing, or accommodative esotropia, are treated with eyeglasses. The power of the eyeglasses is determined by performing a refraction. In most cases of accommodative esotropia, the focusing muscles inside the eye must be relaxed with eyedrops (cycloplegia) to accurately measure the full amount of the child’s farsightedness (hyperopia). About 75% of children with accommodative esotropia will have straight eyes wearing eyeglasses. Glasses will only help the child if they are prescribed accurately and worn full-time. As soon as the glasses are removed, the eyes will cross again. For this reason your child must wear the glasses during all waking hours. In the remaining 25% of patients, glasses alone may not be enough to straighten your child’s eyes. This type of strabismus is referred to as mixed mechanism esotropia. In these cases, eye muscle surgery may be required in addition to glasses. Eye muscle surgery is only used to treat the crossing that is not relaxed by the glasses (the non-accommodative component). That means your child will continue to need glasses to keep their eyes straight even after surgery (for their accommodative component).

What is mixed mechanism esotropia?

When the crossed eyes (esotropia) are caused by both focusing reason (accommodative) and by a muscular reason (non-accommodative), the crossing is referred to as mixed mechanism esotropia. The accommodative component requires to use of glasses. Surgery is often necessary for the muscular imbalance (non-accommodative) part.

Why is it important to have strabismus treated?

The most important reasons to treat eye misalignment problems (strabismus) are first to straighten the eyes and second to restore binocular (3-D) vision. In children it is particularly important to treat eye misalignment problems (strabismus) to preserve normal visual development or assist in the therapy of and the stability of amblyopic therapy.

Click the following links for more information.
Infantile Esotropia
Accommodative Esotropia
Strabismus Surgery