Accommodative Esotropia

Eye crossing that occurs in a child who is not wearing glasses that stops when the child is wearing glasses for farsightedness.

Signs of accommodative esotropia

One eye tends to turn inward (cross-eyed) toward the nose when the child is focusing on something. The other eye will usually be straight. 

The eye crossing is often worse when the child is concentrating on looking at something up close.

The eye crossing may go away completely when the child is not focusing on something.

Causes of accommodative esotropia

When we look at an object, two things happen.

1. The eyes must focus (accommodate) on the object.
2. Our eyes turn in (converge) to look at the object.

Focusing and the eyes turning work together to create good vision. Children who are farsighted, or have difficulty seeing close objects, need extra focusing power to see clearly. This causes the eyes to turn in too much. 

Why it is bad to have crossed eyes

In order to have normal depth perception (3D vision), the eyes must point at the same thing at the same time. When one eye is crossed, a child may not have good depth perception, and the development of fine motor skills may be slow. Over time, the vision in the eye that crosses can become weak. This is called amblyopia, or lazy eye.

Treatment of accommodative esotropia

Glasses are prescribed for farsightedness. When the glasses are being worn, the eyes should not cross. When the glasses are taken off, the eyes will still cross. 

Some children will require a bifocal in their glasses to control their eye crossing for near objects. 

Contact lenses will also work for the treatment of accommodative esotropia. These are usually reserved for older children.

Prognosis

Some, but not all children, will grow out of accommodative esotropia and will no longer require glasses to have straight eyes. This usually occurs around puberty. Some people will need glasses for the rest of their lives to keep the eyes straight.

Troubleshooting Accommodative Esotropia Treatments

Situation

My child will not wear their glasses.

Possible Solutions

In order be comfortable and get the most from their glasses, children must relax their natural focusing ability. If a child will not wear the glasses after a week or so, an eye specialist may be able to prescribe atropine eye drops for a few days. These drops can help to relax a child’s natural focusing of the eye muscles which can help them adapt to the glasses.

Situation

My child says that their vision is blurry when wearing glasses.

Possible Solutions

Children must relax their natural focusing in order to wear their glasses. If blurred vision continues to be an issue, your eye specialist may prescribe atropine eye drops for a few days to relax the child’s natural focusing muscles. This may help clear the child’s vision.

Situation

My child is looking over his glasses when watching television.

Possible Solutions

This can mean that the glasses are too strong or that the child has not adapted to the new glasses by relaxing his normal focusing power. Your eye specialist may want to examine your child again or may want to have your child use atropine drops for a few days to help him relax his focusing muscles.

Situation

My child’s eyes are straight when she looks at something far away, but her eyes are still crossing when she looks at something up close.

Possible Solutions

This usually means that the child needs to have a bifocal added to the glasses prescription. Tell your child’s eye specialist at the next clinic visit.