Accommodative Esotropia

Posted on January 08, 2018

Accommodative Esotropia

By:  Jeffrey D. Colburn, MD

We frequently see young children between the ages of 2 to 4 with new onset eye crossing.  This is often a very stressful concern for the parents who are worried about what could be causing this.  Usually there is a concern about whether this could be something serious like a brain tumor.  While we do have to consider potential serious causes as we evaluate such a patient, almost all of the time new eye crossing in this young age range is related to a condition called Accommodative Esotropia. 

"Esotropia" is the medical word for eye crossing.  "Accommodative" refers to the eye crossing being caused by a focusing problem.  Most children are a little far-sighted and they focus through it and see fine without glasses.   However, some children will have much more far-farsightedness and they have to work really hard (sub-consciously) to focus and see.  This can cause their eyes to cross, usually starting between the ages of 2-4.  Most of these children will then have nice straight eyes once we get them in glasses to deal with their far-farsightedness and let their focusing relax.  So the good news is that when we examine a young patient with new onset eye crossing, and they are fairly far-sighted but have no other signs of trouble, we can feel pretty good about them not having something more serious going on.  The bad news is that they are at risk for worsening eye crossing over time that might require surgery not just glasses, or they might develop amblyopia where the brain turns one eye off and does not learn to use it well.  So it is important to get any concern for eye crossing checked right away by a pediatric ophthalmologist and start treatment right away.

Children with accommodative esotropia will continue to cross their eyes with glasses off.  But if their eyes are straight with the glasses on then they will usually do fine.  Many of them will out-grow the eye crossing by their early teen years though some will continue to have it even as adults.  If eye muscle surgery is ever considered, the goal is again to get eyes straight with their glasses on.  Older children and teenagers may be able to have contact lenses instead of glasses to control their eye crossing.

If your young children or those of someone you know start having eye crossing, get them in for an eye exam right away!