From the Guidelines
Esotropia is a convergent misalignment of the visual axes that requires prompt treatment to prevent long-term vision problems, and the most effective approach typically involves a combination of corrective eyeglasses, vision therapy, and surgery, as outlined in the 2023 preferred practice pattern for esotropia and exotropia 1.
Disease Definition and Categorization
Esotropia can be categorized based on age of onset or underlying causes, including infantile esotropia, acquired esotropia, accommodative esotropia, and nonaccommodative esotropia, among others 1. Understanding the specific type of esotropia is crucial for determining the most appropriate treatment approach.
Treatment Options
Treatment for esotropia depends on the cause and severity of the condition, but may include:
- Corrective eyeglasses to address refractive errors
- Prism lenses to align the images seen by each eye
- Vision therapy to improve eye coordination and strengthen eye muscles
- Surgery to realign the eye muscles and correct the misalignment
Importance of Early Intervention
Early intervention is critical, especially in children, to prevent amblyopia (lazy eye) and ensure proper visual development 1. Patching therapy, where the stronger eye is covered for several hours daily, may be recommended to strengthen the weaker eye.
Monitoring and Follow-up
Regular follow-ups with an ophthalmologist are essential to monitor progress and adjust treatment as needed 1. Without treatment, esotropia can lead to permanent vision problems, including depth perception issues and reduced visual acuity in the affected eye.
From the Research
Definition and Treatment of Esotropia
- Esotropia is a form of strabismus where one or both eyes turn inward 2.
- The treatment of accommodative esotropia requires a thorough evaluation at first presentation to elucidate all factors involved, including the degree of hypermetropia, character of the esodeviation, presence or absence of amblyopia, and the AC/A ratio 2.
Causes and Characteristics of Adult-Onset Esotropia
- Adult-onset esotropia can be caused by various factors, including cranial nerve VI palsy, thyroid eye disease, age-related distance esotropia, and decompensated latent esodeviations 3.
- A study found that the four most common diagnoses for adult-onset esotropia were cranial nerve VI palsy (36%), thyroid eye disease (18%), age-related distance esotropia (15%), and decompensated latent esodeviations (13%) 3.
Surgical Outcomes for Esotropia
- Surgical treatment of esotropia can be effective in achieving acceptable ocular alignment and resolving diplopia [(3,4)].
- A study found that approximately 80% of patients with adult-onset esotropia who underwent strabismus surgery were aligned within 10 prism diopters at the 2-month postoperative follow-up visit, and 72% experienced resolution of diplopia 3.
- Another study found that adjustable strabismus surgery with adjustable sutures was safe and effective in achieving subjective and objective success in patients with esotropia 4.
Factors Influencing Esotropia Outcomes
- Delay to full hypermetropic correction wear in children may influence the outcome of a diagnosis of full versus partially accommodative esotropia 5.
- A study found that longer delays between the time at which esotropia was identified and the time at which glasses were prescribed were associated with a reduced likelihood of an outcome of full versus partially accommodative esotropia 5.