One common form of strabismus, or misaligned eyes, is called esotropia. Esotropia, or "crossed" eyes, occurs when the eyes turn inward towards the nose. Esotropia can be both infantile, when it occurs before six months of age, and accommodative, which is more likely to develop between six months and two and a half years of age.

Pseudostrabismus, or the false appearance of an eye turn, is often mistaken for true esotropia. In these children, the symmetry of the corneal light reflex can help to determine the alignment of their eyes. Infants often have wide, flat nasal bridges and prominent skin folds at the inner corner of their eyes, which give the appearance of crossing eyes.

With accommodative esotropia, when the child focuses the eyes to see clearly, the eyes turn inward. This "crossing" may occur when focusing at a distance, at close range, or both. These children typically have some degree of hyperopia or farsightedness. Eyeglasses reduce the focusing effort and often straighten the eyes. Sometimes bifocals are needed for close work. Sometimes children will not notice an improvement in their vision with their glasses. It is then important for parents to explain that the glasses are helping the child to use both eyes together and not to make objects look clearer. In a partly accommodative esotropia,significant crossing of the eyes persists with glasses and surgery may be required.

Young children withinfantile esotropia should first be checked for an accommodative component to the eye turn. If hyperopia is present, either glasses or phospholine iodide will be prescribed to reveal the amount of the eye turn that is due to focusing. Surgery is never performed to control the accommodative component. In most cases, early surgery, performed after six months of age, can align the eyes.

Esotropia is often treated by surgically adjusting the eye muscles under general anesthesia. The goal of surgery is to get the eyes close enough to perfectly straight so that it is hard to see any residual deviation and to allow binocular vision to develop.

The main sign of esotropia is an eye that is not straight. Sometimes children will squint one eye in bright sunlight or tilt their head in order to use their eyes together.

Amblyopia, or "lazy eye," is closely related to esotropia. Children learn to suppress the double vision associated with esotropia so effectively that the deviating eye gradually loses vision. It may be necessary to patch the good eye and have the child wear eyeglasses before treating the esotropia.

Esotropia left	Esotropia right
Pseudostrabismus

9/25/09