Esotropia is a type of strabismus characterized by the inward deviation of one or both eyes. This condition should be considered a significant eye health issue as it can directly affect visual development and the ability of both eyes to work together. If not identified early and managed appropriately, esotropia can lead to outcomes such as amblyopia (lazy eye) and permanent problems with depth perception. Therefore, regular eye examinations in infancy and childhood are crucial.
What is Esotropia?
Esotropia is a type of strabismus characterized by the inward deviation of one or both eyes. Commonly known as convergent strabismus, it occurs due to an imbalance in the eye muscles, making it difficult for the eyes to focus on the same point together.
Esotropia is not only a cosmetic issue. Particularly when it develops in infancy and childhood, it can adversely affect the healthy development of the visual system. If left untreated, it can lead to amblyopia, loss of depth perception, and insufficient development of binocular vision.
Esotropia can be constant, or it may appear intermittently at times. It may affect one eye or be observed as alternating inward deviation between the two eyes.
What are the Types of Esotropia?
Esotropia is classified into different types based on the time of onset, causes, and progression characteristics. Each type of esotropia may not present the same clinical features, and the management process can differ.
The main types of esotropia are:
Infantile Esotropia
Infantile esotropia is convergent strabismus that typically appears within the first 6 months after birth. In this type, the eye deviation is often constant, and it may not always be easily noticed in the early stages.
Since infantile esotropia can affect the developmental process of the visual system, it is a condition that needs close monitoring. In some cases, issues such as amblyopia and binocular vision problems may accompany it.
Accommodative Esotropia
Accommodative esotropia often develops in association with hyperopia. Efforts by the eyes to focus more sharply for clear vision can cause inward deviation. In this type of esotropia, appropriate use of glasses can help reduce or control the eye deviation. Accommodative esotropia is usually noticed during childhood.
Acquired Esotropia
Acquired esotropia is inward eye deviation that occurs after infancy, developing in childhood or adulthood. Trauma, certain systemic diseases, vision loss, or neurological causes may contribute to this condition.
Intermittent Esotropia
In this type, eye deviation is not constant and occurs under certain conditions. Inward deviation may become more pronounced during periods of fatigue, lack of attention, or illness. If not identified early, intermittent esotropia can become permanent over time.
How is Strabismus (Esotropia) Detected in Children?
Strabismus (esotropia) in children may not always be easily noticeable, especially at an early age. However, certain behaviors and visual clues can be important warning signs for families.
The primary signs of esotropia in children are:
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The appearance of one or both eyes turning inward
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In photographs, one eye appears to look in a different direction during flash photography
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The child frequently tilts their head in the same direction or holds their face at a certain angle to see clearly
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Closing one eye, squinting, or preferring to see with one eye
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Fatigue or inattention when looking at near or distant objects
In infancy, eye deviations may sometimes be temporary; however, to distinguish whether the condition is permanent, it should be diagnosed with an eye examination. Especially inward deviations continuing or becoming more pronounced after 6 months should be evaluated.
What are the Symptoms of Esotropia?
The symptoms of esotropia can vary depending on the degree of eye deviation, whether it is constant or intermittent, and the age of the child. While some children's symptoms are easily noticeable, in some cases, they may present with more subtle or indirect indications.
Common symptoms of esotropia include:
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The eye deviation becomes more noticeable during fatigue, inattention, or illness
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In photographs, eyes appear not to look at the same point
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The child frequently tilts their head in a specific direction or maintains a fixed angle to see clearly
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Closing one eye, squinting, or preferring to see with one eye
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Difficulty in visual attention and focus
How is Esotropia Diagnosed?
The purpose of the diagnostic process is not just to determine whether the eyes are turning inward, but also to evaluate the degree, type, and effects on visual development in detail.
The assessment for esotropia may include:
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Assessment of eye alignment: Examining the orientation of the eyes determines if the inward deviation is constant or intermittent.
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Strabismus measurements: Special tests and measurement methods can determine the angle and severity of the eye deviation.
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Refraction examination: Evaluating the relationship of refractive errors such as hyperopia with esotropia; a cycloplegic refraction may be performed if necessary.
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Visual acuity assessment: Measuring the visual level of each eye separately to explore the risk of amblyopia.
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Binocular vision assessment: Examining the cooperative capacity of the eyes and depth perception.
Examinations for infants and young children are conducted using age-appropriate methods. Observations taken from the family and the child's daily behaviors are also important in the diagnostic process.
What are the Treatment Methods for Esotropia?
The treatment methods for esotropia can be planned based on the type and degree of eye deviation, the patient's age, and the condition of visual development. The primary goal of treatment is to align the eyes, support binocular vision, and prevent amblyopia development in children. Therefore, the treatment approach is tailored to the individual and may include multiple methods.
Glasses Therapy
Some types of esotropia, particularly accommodative esotropia, are related to refractive errors. In such cases, using appropriate glasses can help reduce or control the tendency for inward eye deviation.
Occlusion (Amblyopia) Therapy
If amblyopia (lazy eye) has developed alongside esotropia, occlusion therapy may be applied. This method involves covering the better-seeing eye for specific periods to stimulate the weaker eye.
Orthoptic (Eye Exercise) Approaches
For some patients with intermittent and mild deviations, exercises to support binocular vision capacity may be added to the treatment plan. These applications may not be suitable for every case of esotropia and require a physician's evaluation for decision-making.
Esotropia Surgery
Esotropia surgery is a surgical intervention aimed at balancing the eye muscles. The purpose of the surgery is to align the eyes and support visual coordination. The decision for surgery is made considering factors such as the degree and type of eye deviation, response to previous treatments, and the patient's age. Surgery may be planned alone or in conjunction with glasses or occlusion therapy.
Frequently Asked Questions
Is esotropia only seen in children?
Although esotropia is most commonly seen in childhood, it can also develop in adults. This condition, known as acquired esotropia, may be associated with different health issues.
When should eye deviation in children be taken seriously?
Eye deviations that continue, become constant, or increase over time after the sixth month should be evaluated. Behaviors such as tilting the head, looking with one eye, or covering the eyes should also be considered.
Are esotropia and lazy eye the same thing?
No, esotropia is a type of eye deviation, whereas lazy eye refers to insufficient development of vision. However, if left untreated, esotropia can lead to amblyopia.
Does esotropia correct itself?
Some temporary eye deviations observed in infants during the first months may decrease over time. However, esotropia that continues or becomes more pronounced after the sixth month should be evaluated by a specialist.
