What is the medical term for crossed eyes?

Strabismus: Medical Term for Crossed Eyes

The medical term for crossed eyes is esotropia, which is a convergent misalignment of the visual axes where one or both eyes turn inward. 1

Types of Esotropia

• Infantile esotropia: Presents before 6 months of age, characterized by constant inward deviation that may increase over time and frequent cross-fixation with the fixing eye in adduction 1
• Acquired esotropia: Typically develops after 6 months of age and is more frequent than infantile esotropia 1
• Accommodative esotropia: Related to excessive convergence, usually associated with hyperopia, with typical onset between ages 1-4 years 1
• Partially accommodative esotropia: Some improvement occurs with corrective lenses for hyperopia 1
• Nonaccommodative esotropia: Acquired esotropia approximately equal at distance and near fixation with no significant refractive error or no improvement with correction 1
• Sensory esotropia: Caused by retinal or optic nerve abnormalities 1
• Adult-onset esotropia: Includes conditions like divergence insufficiency, sagging eye syndrome, and strabismus fixus 1

Clinical Features

• Constant or intermittent inward deviation of one or both eyes 1
• May be associated with amblyopia (reduced vision in the affected eye) 1
• Can present with diplopia (double vision), especially in acquired forms 1
• May include additional features such as latent nystagmus, dissociated vertical deviation, or oblique muscle dysfunction 1
• Binocular vision is often impaired 1

Epidemiology

• Strabismus affects 2-5% of the preschool population 2
• Annual incidence of adult-onset esotropia is approximately 6.0 per 100,000 people 1
• Risk factors include premature birth, low birth weight (under 2000 grams), perinatal morbidity, genetic disorders, and prenatal environmental influences such as maternal smoking 1
• Family history increases risk, suggesting genetic components 3, 4

Diagnosis

• Confirmed by cover-uncover test or Hirschberg light reflect test in younger children 1
• Measured using prism and alternate cover test or Krimsky test 1
• Comprehensive evaluation includes sensory testing, motor testing, cycloplegic refraction, and funduscopic examination 1
• Differential diagnosis should rule out pseudostrabismus (appearance of strabismus when there is no actual misalignment) 1

Clinical Significance

• If untreated, can lead to permanent visual impairment through amblyopia 3
• Impacts binocular vision and depth perception 1
• Affects social interactions, self-image, and quality of life 1
• May limit career options that require stereopsis 1
• Can cause psychological distress due to appearance concerns 1, 5

Treatment Considerations

• Early intervention is crucial, especially for infantile and childhood esotropia 3
• Treatment options include:
  • Optical correction with eyeglasses for accommodative forms 2
  • Surgical correction of extraocular muscles 6
  • Pharmacological interventions (botulinum toxin, atropine, miotics) in specific cases 2
  • Vision therapy and exercises 6
• Treatment goals include promoting binocular vision, improving visual function, normalizing appearance, and enhancing social interactions 1

Important Distinctions

• Intermittent esotropia during the first 3 months of life may be normal and does not necessarily predict development of constant strabismus 3
• Esotropia must be distinguished from exotropia (outward deviation of the eyes) 1
• Adult-onset esotropia has different characteristics and management approaches compared to childhood forms 1

Understanding the specific type of esotropia is essential for proper diagnosis and treatment planning, with early intervention being critical to prevent permanent visual impairment.