Esotropia: Definition, Types, Symptoms, Complications, Causes, Risk Factors, Diagnosis and Treatment

It is a condition where one or both eyes turn inward and few people suffer from this condition.

Esotropia can take various forms, some types develop in childhood and others occur in adulthood.

Among the characteristics of the people who suffer from it can be mentioned:

  • The condition is sometimes mistakenly known as lazy eye .
  • Those with esotropia often look like they are crossing their eyes.
  • Untreated esotropia can cause complications in both children and adults.
  • It is a type of misalignment of the eyes , known as strabismus .

Types of esotropia

It can be classified by:

  • Frequency.
  • Age of the patient when the condition develops.
  • Relationship with eye focus or not.

The different classifications include:


The infantile form of the condition begins during the first year of life. Babies with this condition cannot use both of their eyes together.

If one of the eyes turns inward more often than the other, the child is at increased risk for amblyopia, also known as a lazy eye.

Infantile esotropia is usually treated with surgery, glasses, or sometimes Botox injections. Correcting this condition before a child is 2 years old is usually very successful, with only a few experiencing visual problems after the intervention and as they develop and grow.

Other eye problems associated with childhood esotropia include upward drift of the eyes, farsightedness, and nystagmus, which is sudden movement of the eyes.


If the condition develops over the course of years or after development, it is known as acquired esotropia. It can be the result of medical conditions, such as diabetes or other eye problems, such as untreated farsightedness.

Double vision is one of the main complaints of those who suffer from this condition, which becomes a difficulty in performing daily tasks.

People with acquired esotropia can often successfully treat the condition with glasses and vision therapy, although surgical intervention may be necessary for some.


One of the most common forms of strabismus (crossed eye) is accommodative esotropia, which is characterized by the crossing of the eyes that occurs when they struggle to focus to see objects clearly.

This attempt to focus is known as “accommodation.” People with accommodative esotropia, also known as refractive esotropia, are generally farsighted.

People can control accommodative esotropia by wearing prescription glasses or contact lenses. If this fails, they may require surgery.

In addition to the types of this condition, esotropia can be classified as constant or intermittent.

Constant esotropia: it is present all the time.

Intermittent esotropia: appears and disappears.

For example, intermittent esotropia can only be noticed when a person is constantly:

  • Tired.
  • Ill.
  • Looking only at objects that are nearby.
  • Looking only at objects that are far away.


Symptoms include:

  • I turn inward of the eyes.
  • Crossing of the eyes.
  • Lazy eye.

People with esotropia may find that they cannot focus their eyes on the same place at the same time and that they can only see objects fully with one eye.

Complications of esotropia

Babies and young children may experience:

  • Loss of 3-D vision.
  • Problems with depth perception.
  • Amblyopia (loss of vision in the crossed eye).

However, if congenital esotropia is treated in childhood, these complications are less likely to occur in the long term.

Older children and adults who acquire esotropia can develop:

  • Diplopia (double vision).
  • Decreased binocular vision (the ability of the eyes to work together).
  • Depth perception problems.


Strabismus can be inherited in some cases, although not all family members will exhibit the condition or the same form of the disease.

There are several types of strabismus, esotropia being the most common. There is a genetic component to strabismus and the condition tends to run in families.

However, not all family members will develop strabismus, and those who are affected will not necessarily experience the same forms.

Risk factor’s

Some factors increase your risk for esotropia, including:

  • Family history of strabismus.
  • Having another eye disorder, such as cataracts or glaucoma .
  • Certain medical conditions, such as diabetes and an overactive thyroid.
  • Neurological conditions, including excess fluid in the brain.
  • Premature birth.


People with esotropia symptoms will generally be seen by an ophthalmologist or optometrist, who will take a complete medical and family history before conducting eye exams.

The tests used will assess:

  • Clarity of vision in each eye.
  • Clarity of vision in both eyes together.
  • How well the eye refracts light.
  • Degree of hyperopia.
  • Retinal function.


Treatment for esotropia depends on the severity of the condition and how long it has been present.

Other factors that inform the treatment plan include whether there is misalignment in one or both eyes, and whether the esotropia is accommodative or not.

Treatment always aims to:

  • Eye alignment.
  • Correct double vision.
  • Reducing vision problems with both eyes.
  • Correcting lazy eye.

Treatment options include:

  • Glasses or contact lenses – This is often the first line of treatment. Prescription glasses can correct misalignment of the eye or farsightedness. If a person’s eyes still cross when wearing the glasses, they may require a bifocal lens.
  • Vision therapy: Eye exercises can help strengthen the function of the eye and the muscles around the eye to improve vision. One form of vision therapy involves wearing a patch over the unaffected eye to improve the function of the crossed eye.
  • Botox injections: Botox can be injected to realign the eyes of some people with mild esotropia.
  • Surgery: Some people may require surgical treatment to change the length of the muscles around the eyes, although this does not always completely eliminate the need for glasses or contact lenses.

The surgery is mostly performed on babies with esotropia, but some adults may also have a surgical procedure.