Accommodative Esotropia

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Accommodative Esotropia

WHAT IS ACCOMMODATIVE ESOTROPIA?

Accommodative esotropia is when the eyes don’t line up properly, which is also called strabismus. It’s a common problem in children and is sometimes called refractive esotropia or "crossed eyes." This happens when one or both eyes turn in while trying to focus on something. It usually happens to children who are more farsighted than normal. Farsightedness means the eyes need to work harder to see things clearly, especially close up. This effort is called accommodation. The closer an object is, the harder it is to focus. Sometimes, this can cause the eyes to cross.

WHY IS ACCOMMODATIVE ESOTROPIA A CONCERN FOR CHILDREN?

When a child’s eyes cross early on, it can stop their vision from developing properly. If one eye is not used properly, it may not develop normal vision (this is called amblyopia or "lazy eye"). A child may also have trouble with depth perception (the ability to see how far away things are using both eyes at the same time). If the eyes are treated early, they can develop normal vision. However, eye crossing is never normal, except in the first few months of life. If you think your child has crossed eyes, take them to a pediatric ophthalmologist.

DO ALL CHILDREN WITH FARSIGHTEDNESS HAVE ACCOMMODATIVE ESOTROPIA?

No, not all children who are farsighted will have accommodative esotropia. Many children are slightly farsighted, but their eyes will not cross. The more farsighted a person is, the more likely their eyes will cross. Sometimes, eye problems like this can run in families.

HOW IS ACCOMMODATIVE ESOTROPIA TREATED?

The first way to treat accommodative esotropia is with eyeglasses or contact lenses. These can help fix the child’s farsightedness and make focusing easier. The glasses reduce the amount of effort needed to focus and help the eyes straighten out. Children with accommodative esotropia should wear their glasses all the time.

Children with Accommodative Esotropia

Fig. 1:  The picture above shows how the eyes should be straight when the correct glasses are worn. 

WHAT HAPPENS AFTER A CHILD STARTS WEARING GLASSES FOR ACCOMMODATIVE ESOTROPIA?

Even after a child wears glasses, their eyes might still cross when the glasses are off. In fact, the crossing may seem worse at first. But if the eyes are straight with the glasses on, then the vision should develop normally. It’s important for the child to have follow-up visits with their eye doctor to make sure the eyes stay straight and to check for problems like amblyopia (decreased vision in one or both eyes) which is common in this type of strabismus.

WHAT ROLE DOES SURGERY PLAY IN ACCOMMODATIVE ESOTROPIA?

Surgery is only needed if glasses don’t fully straighten the eyes. If this happens, eye muscle surgery might be needed to fix the remaining eye crossing while wearing glasses. Surgery usually doesn’t get rid of the need for glasses, but it can help straighten the eyes better when the glasses are on. The eyes may still cross when the glasses are off. Surgery is usually done in childhood to help the child develop normal depth perception. It can also be done later in life for people who do not like how their eyes look when they are crossing.

WHY DO SOME CHILDREN WITH ACCOMMODATIVE ESOTROPIA REQUIRE BIFOCALS?

Some children may cross their eyes more when looking at things close up, like when reading, even if they wear glasses. These children might need bifocals, which have a special section at the bottom to help them focus even more on things up close.

CAN CHILDREN OUTGROW ACCOMMODATIVE ESOTROPIA?

Yes, some children outgrow accommodative esotropia as they get older and become less farsighted. This usually happens as they grow through grade school and into their teen years. It’s hard to know for sure if a child will outgrow the need for glasses or the eye crossing.

ARE CHILDREN WITH ACCOMMODATIVE ESOTROPIA CANDIDATES FOR REFRACTIVE SURGERY (SUCH AS LASIK)?

Children who don’t outgrow their need for glasses may be able to have refractive laser surgery when they are older. LASIK surgery is only approved for people aged 18 or older. Whether a child can have this surgery depends on their individual situation, so it’s important to talk to both a pediatric ophthalmologist and refractive surgeon.

Updated: 12/2024


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