What is an accommodative esotropia?

What is an esotropia?

Esotropia means the tendency for the eye to drift in towards the nose.

What is an accommodative esotropia?

Accommodative esotropia is where one or both of someone’s eyes have a convergent squint (inward turn) with hypermetropia (long-sightedness).

This video from the SquintClinic.com explains esotropia well.

How your child sees the world

Being long-sighted (hypermetropic) makes everything appear blurred, both in the distance and close up.

However, because the natural lens in a child’s eye is still very elastic, we can try to bring things into focus by changing the shape of the lens. If this is being done too often, it can lead to eye strain and headaches and the convergent squint will become more noticeable if they are straining to see clearly.

How your child looks

Your child’s eyes have an inward-turn (convergent squint or ‘esotropia’) which is usually more noticeable when they take their glasses off or look at something close up.

Only one eye will turn inwards at a time, some children will alternate or swap which eye turns inwards and which they focus with.

This is nothing to worry about and shows they have good vision in both of their eyes.

How did they get it?

Most children are slightly long-sighted. If children are more long-sighted than other children their age, or more prone to have a squint, then the long-sightedness can cause the eyes to turn inwards. It is not known why some children are more long-sighted or more prone to squint than others. Sometimes it can run in the family, at other times the child is the only one to wear glasses.

How can the team at the hospital tell?

Your child will have had a number of tests with different clinicians.

The orthoptist will assess vision, by eye movements if your child is unable to speak yet, or by asking your child to name or match letters or pictures. They then check your child’s eye movements to see whether there is a squint (a misalignment in the eyes).

The nurse will put in eye drops which are used to make the pupil larger. This temporarily stops the focusing mechanism of the eye by relaxing the muscle that controls the shape of the lens. The drops normally take 30 to 45 minutes to work.

The optometrist or ophthalmologist will performs a glasses check for your child. The prescription is based on the shape of your child’s eyes and is an objective test (not based on how well your child performed the vision testing). However, all the results will be taken into account when choosing the correct prescription for your child.

How is it treated?

The first step is to correct the long sightedness by giving your child glasses. These should be worn during all waking hours, except when swimming.

The glasses have 3 effects:

• they allow your child to relax the lens of their eyes to avoid putting too much effort into focusing
• they allow your child to develop clear vision in both eyes
• they reduce the inward squint or ‘esotropia’

For many children, the only treatment they need for their squint is glasses to keep their eyes straight. Glasses will continue to be worn until your eye specialist (the hospital or local optometrist) feels there is no longer a need for them. If glasses are needed in the longer term, alternatives can be considered as your child gets older, such as contact lenses.

What if the inward squint is still noticeable with the glasses on?

If your child’s eyes continue to turn inwards whilst wearing their glasses, surgery can be considered.

It is important to understand that surgery only corrects the squint and it does not help your child to see clearly. Most children will still need their glasses after the operation to have the best possible vision. The surgery will be based on the amount of residual squint whilst wearing their glasses. Therefore even after successful surgery, without the glasses the eye will continue to turn inwards.

Surgery has risks and does not work in all cases and this will be discussed further with your surgeon. There are no exercises to correct this particular type of squint.