Esotropia, commonly called crossed eyes, is a condition that affects 1-2 percent of the population whereby a person uses only one eye to look at objects while the other eye turns inward. Esotropia is a form of strabismus which is the inability of both eyes to align together to look at an object.
Symptoms of esotropia
Following are the common symptoms of esotropia:
You may have blurred or distorted vision due to inward deviation of eyes
You may look cross eyed
You may develop amblyopia (a condition in which vision is suppressed in one eye)
You may find it difficult to focus at an object that is nearby or at distance
You may find yourself reading or viewing an object with just one eye
Why do we need both of our eyes for great vision?
Esotropia or crossed eyes is not just a cosmetic issue, it deeply impacts many aspects of a person's life by disturbing their binocular vision. Binocular vision is the term that refers to the use of both of our eyes together to see the world. For a person with esotropia things that require both eyes working as a team become much more difficult. For example when we read, use a phone, drive a car, ride a bicycle, walk down the street, or play sports we use binocular vision to perform these tasks. When a functional optometrist works with an esotropic patient, the goal is to restore binocular vision.
How is Esotropia Treated?
Esotropia must be detected and treated early in order to be effectively treated. During the early stages of development, the child's brain is adaptive and has a high chance of responding well to treatment. The good news is that there are effective treatments for esotropia for patients of all ages. Treatment of esotropia is determined on a case by case basis, where the functional optometrist will assess the underlying causes of the esotropia and the ideal treatment for that patient.
Treatment for esotropia involves treating the underlying cause, which may include:
Double vision
Weak extraocular muscles (responsible for eye movements)
Farsightedness (hyperopia)
Amblyopia (lazy eye)
Binocular vision dysfunction
Vision therapy: Vision therapy has been shown to be an effective, permanent, and non-invasive way to treat esotropia. The goal of vision therapy is to train the brain to use both eyes in tandem to achieve great vision. Vision therapy for esotropia is often done in combination with special prism lenses. The therapy is done in office under the guidance of the functional optometrist and a vision therapist. The in office sessions follow a series of repeated exercises,tailored to the patient's visual deficits and progress.
Patching is another treatment option especially in patients with acquired esotropia caused by amblyopia. This option forces the brain to utilize the eye that has been ignored. For best results patching should be done in combination with vision therapy in order to promote binocular vision once the amblyopic eye is being used.
Surgery may be performed on your extraocular muscles to fix the misalignment of your eyes. It is performed by an ophthalmologist which may be recommended by our optometrist if necessary. Ideally surgery is done in combination with vision therapy, which allows for the combination of fixing the muscle alignment while reintegrating binocular vision for the patient through therapy.
With eyeglasses, accommodative esotropia can be treated by reducing focusing effort and convergence of the eyes.
Eyeglasses with prisms may also be prescribed to correct the misalignment of the eyes, effectively correcting esotropia.
Our eye movements are controlled by extraocular muscles. These muscles keep our eyes aligned when we are looking at an object. If there is a problem with these muscles it may result in different types of eye misalignments such as esotropia.
A patient's family history may also contribute to this condition. Approximately 30% of children with strabismus have a family member with the same condition.
Esotropia can also be caused by:
Refractive errors such as farsightedness
Poor vision in one eye
Head injuries
Neurological issues such as down syndrome, cerebral palsy, hydrocephalus, brain tumors
Certain systemic diseases, like hyperthyroidism or diabetes
Types of Esotropia
Intermittent esotropia
This type of esotropia does not cause eye deviation constantly. If a person has this type of esotropia, their eyes may deviate inward after doing near work for a long time.
Infantile esotropia
Infantile esotropia usually manifests within the first six to twelve months of life. Most children develop controlled eye movements before the age of 6 months, but they don't have them during the first few months of life. Esotropia in infants is evident by a large angle deviation. It is also associated with latent nystagmus.
Accommodative esotropia
Typically, this type of esotropia develops between 1 and 4 years of age. Initially, it is intermittent, but over time it becomes more frequent. It usually occurs in children who are more farsighted than usual. Their eyes have to work harder to see clearly when viewing an object that is up close. Due to this excess effort, the eyes become over-converged or crossed.
Acquired esotropia
Unlike esotropia that develops earlier in life, acquired esotropia develops later in life. It could be due to untreated hyperopia (inability to close up objects clearly), double vision, lazy eye (amblyopia) or diabetes.
Sensory esotropia
This type of esotropia occurs in children less than 4 years old. A child with impaired vision in one eye is most likely to suffer from this condition. To get clear vision, our brain must fuse images from both eyes. When one eye does not have good vision, it drifts inwards causing esotropia.
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Strabismus refers to the misalignment of the eyes, where one or both eyes may turn inwards, outwards, upwards, or downwards. Esotropia is a specific type of strabismus where one or both eyes turn inwards towards the nose. In essence, esotropia is a subtype of strabismus. If there's any suspicion of eye misalignment, it's essential to consult an eye doctor for a comprehensive evaluation.
Esotropia is diagnosed through a functional eye exam conducted by an optometrist. This exam assesses eye alignment, binocular vision, and the eyes' movement patterns. Specialized tests, like the cover test, can determine the presence and degree of esotropia. If esotropia is suspected, timely consultation with an eye doctor is crucial to determine the best management approach.
Strabismus is not primarily a brain "disorder." However, it involves the brain's eye muscle control system. The eyes' alignment depends on the coordinated function of multiple muscles, controlled by cranial nerves, which are, in turn, managed by the brain. Strabismus can result from issues in the muscle, nerve, or brain pathways that control eye movements.
Summary
Esotropia is a form of strabismus in which one eye drifts inwards towards the nose while looking at an object that is closeby or at distance. There are many types of esotropia, which can be caused by double vision, amblyopia, hyperopia, weak extraocular muscles, or neurological conditions. Depending on the underlying cause, esotropia may be treated with eyeglasses, patching, vision therapy, surgery, and prisms. A vision therapy program can provide lasting effects and reduce the symptoms of esotropia and is often combined with other treatment options such as surgery or patching for better results. No matter how big or small your esotropia angle is, we can help you manage it and deal with it.
