Esotropia is an inward eye turn of the eyes when looking at distance, near or both. The eyes adopt what is more commonly known as a ‘cross-eyed’ appearance.
This may be congenital from birth or acquired in the early years of life, often prior to commencement of primary school.
Most commonly seen in association with an Accommodative dysfunction, the esotropic child will usually have a high degree of Hyperopia (longsightedness) associated. As the individual focuses excessively to control the hyperopia, eventually when control is lost on or both the eyes may turn inwards.
This is sometimes constant but more commonly intermittent, ie occurs when looking in certain directions or when tired or when viewing new things such as when starting pre-school.
In an Accommodative Esotropia, treatment often only requires early intervention with full time spectacle wear. If the eyes are kept in the straight position by the spectacle correction then chances of Amblyopia are reduced, but not eliminated altogether.
It is common for spectacle prescriptions in the early stages of treatment to increase rapidly, this can be alarming for the parents but it is necessary to keep the prescription at its optimal correction to allow the best chance of binocular vision later in life.
Commonly a prescription will increase during childhood often to moderate or even reduce later in the teenage years.
The most common observation by parents of children with an accommodative esotropia is that they may have not noticed, or only rarely noticed, the eye turn in their child prior to getting spectacles. Yet since having the glasses they have noted the eye turn increase when the spectacles are taken off, reassurance is given that this is a normal occurrence.
As the visual system utilises the spectacle correction to keep the eyes straight until later in life often the eye turn will increase without the spectacles. This does not mean the spectacles are ‘ruining’ your child’s eyes, rather it is a confirmation that without adequate spectacle correction the eye turn may be even greater or the incidence of Amblyopia far more likely.
Vision Therapy is commonly required to help train the child to use their eyes together in a more efficient manner.