Esotropia: Types, Causes & Treatment

Esotropia, a type of strabismus, affects approximately 2 to 4 percent of the population and can happen at any age. This condition, also known as crossed eyes, can have various causes and may require different forms of treatment. 

What Is Esotropia?

Esotropia is a condition where the eyes turn inward instead of looking straight ahead. It is a type of strabismus, also known as crossed eyes, and can affect one or both eyes. If left untreated, this condition can worsen over time and cause difficulty with vision. 

To help with this, people with esotropia may need to wear glasses or patches over one eye. It is important to see a doctor if you think you or someone you know might have esotropia, so it can be treated properly.

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Children & Esotropia

Esotropia is a common condition that primarily affects children. According to the American Journal of Ophthalmology, esotropia is the most common type of strabismus in children, accounting for about 33 percent of all cases. It is most commonly diagnosed in infants and young children, but it can occur at any age. 

If you suspect that your child may have esotropia, it is important to speak with a pediatric eye specialist as soon as possible.

Types of Esotropia

There are different types of esotropia, each with its own causes and characteristics. Some types of esotropia are present at birth, while others develop later in life.

Here are the different types of esotropia and their key features:

Infantile Esotropia

Infantile esotropia, also known as congenital esotropia, is a type of esotropia present in babies within the first year of life. It is often constant. It is caused by misaligned eye muscles or problems with eye development in the womb.

Accommodative Esotropia

Accommodative esotropia is a type of esotropia that starts after the age of 1. It is caused by an overactive focusing reflex in the eyes. 

When a child with accommodative esotropia tries to focus on something up close, the eyes may turn inward (toward the nose) as a result of the overactive focusing reflex.

Non-Accommodative Esotropia

Non-accommodative esotropia is a type of esotropia that is not caused by an overactive focusing reflex in the eyes (as is the case with accommodative esotropia). Instead, it is caused by other factors, such as muscle imbalances or neurological problems. As such, this condition cannot be treated with glasses.

Divergence Insufficiency Type Esotropia

Divergence insufficiency type esotropia is a type of esotropia that affects adults over the age of 30. This condition is characterized by eyes that turn inward more when looking at distant objects than at close ones. 

This type of esotropia may also be accompanied by a reduced ability to use both eyes together to see clearly. 

Microtropia/Monofixation Syndrome

Microtropia, also known as monofixation syndrome, is a condition in which a person has a central area of vision loss in one eye but is able to use the other eye to see clearly. This can lead to a lack of ability to see depth and spatial relationships. 

As a result, people with this condition may have a mild to moderate degree of difficulty using both eyes together.

Sensory Esotropia

Sensory esotropia is a type of misalignment that occurs when one eye cannot see as well as the other. This condition is more common in children under the age of 4 and may be caused by various organic factors. 

Children with sensory esotropia may turn their eyes inward in an effort to use the eye with better vision. Older children or adults with sensory esotropia may develop a sensory exotropia, in which the eyes turn outward.

Consecutive Esotropia

Consecutive esotropia is a type of misalignment of the eyes that can occur when someone who previously had their eyes turning outward (exotropia) now has their eyes turning inward (esotropia). This change in eye alignment can be caused by surgical overcorrection or other factors. 

How Treatment Is Affected by Esotropia Type

It’s important to note that the specific treatment for esotropia depends on the type and severity of the condition. In some cases, eyeglasses or eye patches may be used to correct the misalignment, while in other cases, surgery may be necessary.

Contact your health care provider to determine the best course of treatment for your specific situation.

Symptoms of Esotropia

The specific symptoms of esotropia can vary depending on the type and severity of the condition, but some common symptoms include the following:

• Double vision: When the eyes are misaligned, it can cause double vision, which is the perception of two images of a single object.
• Eye strain: Misaligned eyes may cause strain, which can lead to fatigue, headaches, and discomfort.
• Difficulty reading: Esotropia can make it difficult to focus on text or other small details, making reading and other close tasks more difficult.
• Crossed eyes: In some cases, esotropia may be visible to others as crossed eyes, where the eyes appear to be pointing in different directions.
• Problems with spatial perception: Children with esotropia may have difficulty with spatial perception, affecting their ability to judge distances and perform activities such as catching a ball or riding a bike. 

It’s important to note that the specific symptoms of esotropia may vary depending on the type and severity of the condition. If you or someone you know is experiencing any of these symptoms, it’s important to speak with a health care provider for proper diagnosis and treatment.

Causes of Esotropia

There are several potential causes of esotropia. Here are some of the leading ones:

• Refractive errors: Patients with esotropia may have a refractive error, such as nearsightedness or farsightedness, which can cause their eyes to turn inward. Wearing glasses or contacts can help correct this problem.
• Focusing problems: Children with esotropia may have difficulty focusing their eyes, which can cause the eyes to turn inwards. This can be caused by problems with the muscles that control the eye or with the brain’s ability to process visual information.
• Developmental issues: People with esotropia may have a problem with the way their eyes develop, which can cause the eyes to become misaligned. This can be due to genetics or other factors that are not yet fully understood.
• Medical conditions: Certain medical conditions, such as premature birth or brain injuries, thyroid eye disorders, or vascular problems, can cause esotropia.
• Eye muscle imbalance: Children with esotropia may have a problem with the balance of muscles that control the movement of their eyes, which can cause the eyes to turn inward.
• Family history: Children with a family history of esotropia or other eye conditions may be more likely to develop esotropia themselves. 

Early treatment can help to improve vision and prevent long-term problems with eye muscle control. It is important to have a child with esotropia evaluated by an eye doctor to determine the cause and appropriate treatment.

Diagnosis 

To diagnose esotropia, an eye doctor will perform a comprehensive eye exam to assess the following:

• Vision
• Eye movement
• Muscle balance

During the exam, the eye doctor may ask the patient to do the following:

• Follow a light or object with their eyes
• Look at a chart of letters or numbers from different distances

These tests can help the eye doctor determine if the eyes are misaligned and if there are any problems with eye movement or focusing. The eye doctor may also use special equipment, such as a retinoscope or a phoropter, to do the following:

• Measure the patient’s refractive error
• Determine if glasses or contacts are needed
• Examine the inside of the eye and check for any abnormalities or injuries

If esotropia is suspected, the eye doctor may refer the patient to a pediatric ophthalmologist or a neuro-ophthalmologist for further evaluation and treatment. Early treatment can improve overall vision and prevent long-term problems.

Treatment of Esotropia

Treatment for esotropia depends on the severity of the condition and the underlying cause. Some standard treatment options include the following:

• Glasses or contacts: Glasses or contacts may be prescribed to correct any refractive errors that may be contributing to the misalignment of the eyes.
• Eye patches: Children with esotropia may be prescribed eye patches to help improve the muscle balance of the eyes. The patch is worn over one eye, forcing the patient to use the other eye and help strengthen its muscles.
• Surgery: In some cases, surgery may be necessary to correct esotropia. This can involve repositioning the muscles that control the movement of the eyes to improve eye alignment.
• Vision therapy: This involves a series of exercises and activities designed to improve eye movement and coordination. It may be beneficial for children with esotropia.
• Injections of botulinum toxin: This involves injecting small amounts of Botox into the muscles that control eye movement, which helps to weaken the muscles and improve eye alignment.

Complications if Untreated

Esotropia, if left untreated, can have serious complications. Early treatment is essential to prevent long-term problems with eye muscle control and vision.

Some potential complications of untreated esotropia include the following:

• Reduced vision: Esotropia can cause reduced vision in one or both eyes, leading to problems with vision development and visual acuity.
• Amblyopia (lazy eye): If esotropia is not treated, it can cause amblyopia, a condition in which one eye does not develop normal vision. This can lead to decreased visual acuity in the affected eye and cause problems with depth perception and eye coordination.
• Strabismic amblyopia: Untreated esotropia can also cause strabismic amblyopia, a condition in which the brain begins to ignore visual input from one eye, leading to decreased visual acuity in that eye.
• Difficulty with visual tasks: Children with esotropia may have difficulty with visual tasks such as reading or watching television.
• Social and emotional problems: Children with untreated esotropia may experience social and emotional issues due to appearance or vision difficulty.

It’s important to address esotropia as soon as possible to avoid these complications and improve vision and eye muscle control. 

References

1. Esotropia. (December 2022). StatsPearl.

2. Strabismus. (August 2022). National Library of Medicine.

3. Esotropia. (November 2020). American Academy of Ophthalmology.

4. Non-Accommodative Esotropia and Botulinum Toxin Therapy. (February 2018). University of Iowa.

5. Common Forms of Childhood Strabismus in an Incidence Cohort. (September 2007). The American Journal of Ophthalmology.

6. Early Onset of Acquired Comitant Nonaccommodative Esotropia in Childhood. (March 2012). Investigative Ophthalmology & Visual Science: An ARVO Journal.

7. Divergence Insufficiency Esotropia: Surgical Treatment. (April 2019). American Orthoptic Journal.

8. Monofixation Syndrome. (December 2021). American Academy of Ophthalmology.

9. Sensory Esotropia. Atlas of Ophthalmology.

10. Last Guidelines Overview of Consecutive Esotropia Management: Review Article. (October 2021). Egyptian Journal of Hospital Medicine.

11. Amblyopia (Lazy Eye). (September 2022). National Eye Institute.

12. Risk Factors for Accommodative Esotropia Among Hypermetropic Children. (February 2005). Investigative Ophthalmology & Visual Science.

13. Childhood Esotropia: Child and Parent Concerns. (August 2016). JAAPOS.

14. Essential Infantile Esotropia: A Course of Treatment From Our Experience. (July 2021). Frontiers in Pediatrics.