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Expert Eye Care for Esotropia

Skilled pediatric ophthalmology and adult strabismus experts at UT Southwestern Medical Center have years of expertise in treating people with esotropia, sometimes called crossed eyes. Our doctors offer advanced care, such as surgery and prescribing proper glasses, to correct vision and realign the eyes.

What is Esotropia?

Esotropia is a type of strabismus (eye misalignment) in which one or both eyes turn inward. Although the condition occurs most commonly in infants and children, it can develop at any age.

Types of Esotropia

Esotropia is categorized by:

  • Age at onset, either infantile/congenital (present since birth) or acquired, which usually develops in children from ages 1 through 8
  • Frequency: Intermittent or constant
  • Treatment required: Glasses, surgery, or both, for accommodative esotropia or partially accommodative and nonaccommodative esotropia, respectively

Causes of Esotropia

In a healthy eye, muscles around each eye work together to control eye movement, enabling both eyes to focus on the same subject. In a person with esotropia, the muscles are not coordinated, causing one or both eyes to look inward and focus on different subjects.

Factors that can increase the risk of developing esotropia include:

  • Brain disorders such as cerebral palsy, hydrocephalus, and brain tumors
  • Family history of any type of strabismus, amblyopia (“lazy eye”), childhood cataract, or glaucoma
  • Genetic disorders that affect the eye such as Down Syndrome
  • Poor vision
  • Premature birth
  • Stroke or other vascular problem (in arteries or veins)
  • Systemic conditions such as diabetes or hyperthyroidism
  • Thyroid eye disorders such as Graves’ disease

Esotropia Symptoms

The most noticeable 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 will suppress one image so they don’t experience a double image.

Double vision is the most common symptom in adult-onset esotropia. These patients can also experience blurry vision or decreased visual field.

Other symptoms include difficulty with depth perception.

Diagnosing Esotropia

At UT Southwestern, our ophthalmologists begin the evaluation by discussing the patient’s personal and family medical history. Our doctors then perform a comprehensive medical eye exam that includes one or more of the following tests:

  • Vision test
  • Motor sensory exam, including an ocular alignment test and extraocular muscle movement evaluation
  • Cycloplegic refraction tests, with dilating eye drops, to check refraction without the eye being able to autofocus
  • Slit-lamp exam to look at structures inside the eye
  • Fundus examination using a specialized microscope to see the details of the retina

Treatment for Esotropia

The treatment goals include correcting refractive error, treating double vision and/or amblyopia (“lazy eye”), re-establishing proper eye alignment, and, if necessary, assisting both eyes to work together to focus.

UT Southwestern eye specialists offer treatment options such as:

  • Glasses, sometimes with bifocal or prism lenses, as needed
  • Eye patch on the stronger eye to strengthen the vision of the weaker eye in people with amblyopia
  • Surgery to align the eye muscles

In children with congenital/infantile esotropia, surgery is almost always the recommended treatment. Glasses might be recommended to correct refractive error and help improve the alignment of the eyes.

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