Infantile Esotropia

This is the crossing of one or both eyes inward toward the nose that starts before a child who does not need glasses and who has no neurological problems is 6 months old.

Cause of infantile esotropia

Nobody really knows the cause of the problem. Some people think that the affected child is born with an abnormality in the brain mechanism that causes the eyes to work together. 

Other problems…

Infantile esotropia is rarely an isolated problem. There are several conditions that can be present at the time the crossing is first noted or can develop later in childhood.

• Inferior oblique muscle overaction – When the child looks to the side, the eye looking toward the nose moves upward
• Dissociated vertical deviation – When the child is inattentive or daydreaming, either eye may drift upward toward the ceiling
• Latent nystagmus – When one eye is covered, the other eye may appear to dance around until both eyes are uncovered again
• A or V pattern – When a child looks up or down, the eye crossing may get worse
• Amblyopia – Reduced vision in one eye
• Reduced or absent stereopsis – Absence of fine depth perception, such as that needed to thread a needle

Symptoms of infantile esotropia

Most of the time, there are no symptoms of infantile esotropia other than the actual eye crossing. Children with this problem do not have double vision and can usually see well out of one or both eyes.

Treatment of infantile esotropia

Surgery on the eye muscle is the most commonly offered treatment for the eye movement and position abnormalities. Some surgeons offer repeated injections of botulinum toxin (Botox®) as a treatment option.

Prognosis

Most children will achieve a significant improvement in their eye alignment with surgery. Recurrence is common, however, and follow-up surgery is frequently needed.

Age Considerations

It is better to treat infantile esotropia with surgery early in life.