esotropia

Esotropia, also known as crossed eyes or inward deviation, is a type of strabismus where one eye turns inward toward the nose, while the other eye remains straight. This misalignment can make it challenging for both eyes to focus on the same object at the same time.

Characteristics:

• One eye turns inward, while the other eye remains straight
• Can be caused by a variety of factors, including accommodative esotropia (associated with activation of the accommodation reflex) [3]
• May be accompanied by symptoms such as seeing double, closing or covering one eye when doing close work, and tilting or turning the head [6]

Types:

• Infantile esotropia: a type of esotropia seen in the first year of life
• Accommodative esotropia: a convergent deviation of the eyes associated with activation of the accommodation reflex [3]
• Sensory esotropia: an inward eye-turn associated with something depriving the macula (center of best vision) of visual stimuli

Symptoms and effects:

• Difficulty focusing on objects due to misalignment
• Seeing double or experiencing diplopia
• Head tilting or turning to compensate for misalignment
• Potential long-term effects, such as amblyopia (lazy eye), if left untreated [8]

References:

[3] Accommodative esotropia is defined as a convergent deviation of the eyes associated with activation of the accommodation reflex. [6] Symptoms of accommodative esotropia may include seeing double, closing or covering one eye when doing close work, and tilting or turning the head. [8] In esotropia, one eye turns inward while the other remains straight, making it challenging for both eyes to focus on the same object at the same time.

Esotropia Signs and Symptoms

Esotropia, also known as strabismus, is a condition where one or both eyes turn inward. The most noticeable sign of esotropia is the crossing of one or both eyes, usually intermittently at first. Sometimes there are no symptoms of esotropia.

Common Signs:

• Inward turning of the eyes
• Crossing of the eyes
• Lazy eye

Additional Symptoms:

• Eyes that look misaligned or don't move together
• Squinting or turning the head to see better
• Problems with depth perception
• Blurred vision, tired eyes, sensitivity to light, or double vision (in older children)

These symptoms can vary in severity and may not always be present. If you suspect someone has esotropia, it's essential to consult a medical professional for proper diagnosis and treatment.

References:

• [1] Esotropia is an eye misalignment that causes one or both eyes to turn inward.
• [2] The most noticeable sign of esotropia is the crossing of one or both eyes.
• [3] Symptoms of esotropia include inward turning of the eyes, crossing of the eyes, and lazy eye.
• [4] Symptoms may also include eyes that look misaligned or don't move together, squinting, or turning the head to see better.
• [5] Older children may complain about blurred vision, tired eyes, sensitivity to light, or double vision.

Esotropia, also known as crossed eyes, can be diagnosed through various tests and examinations. Here are some common diagnostic methods used to assess esotropia:

• Visual acuity test: This test measures the sharpness of your vision in each eye. It's a crucial step in diagnosing esotropia.
• Refraction test: This test uses corrective lenses to measure how well your eyes focus light. It helps determine if you have any refractive errors that may be contributing to esotropia.
• Alignment and cover tests: These tests assess the alignment of your eyes and can help diagnose esotropia. The cover test, in particular, is a useful tool for screening strabismus (eye misalignment).
• Light reflex test: This test evaluates the corneal light reflex to check for any misalignment.
• Brückner test: This test uses an ophthalmoscope to compare the red reflexes of your eyes and can help diagnose esotropia.
• Cover test: This is a simple yet effective test that involves covering one eye while looking at a distant target. It helps determine if there's any misalignment between the two eyes.
• Comprehensive eye examination: A thorough eye exam by an ophthalmologist or optometrist can help diagnose esotropia and rule out other conditions.

According to [2], the cover test can be used to screen for strabismus, including esotropia. When the left eye is covered, the right eye moves inward, indicating a right esotropia.

In addition to these tests, a complete exam of the eyes is necessary to determine the likely cause of esotropia [5]. Careful attention should be paid to the deviation in alignment and any other symptoms that may be present.

References:

[1] - Visual acuity test [2] - Cover test for strabismus screening [3] - Refraction test for refractive errors [4] - Alignment and cover tests for esotropia diagnosis [5] - Complete eye exam for esotropia diagnosis

Treatment Options for Esotropia

Esotropia, also known as crossed eyes, can be treated using various medications and therapies. The goal of treatment is to align the eyes properly and improve vision.

• Miotics: Miotics are a type of medication that can help treat esotropia by relaxing the muscles around the eye. They work by reducing the amount of focus on the stronger eye, allowing the weaker eye to catch up (Chatzistefanou, 2000 [3]). Examples of miotics include echothiopate iodide and pilocarpine.
• Atropine: Atropine is an anticholinergic agent that can be used to treat amblyopia, a condition often associated with esotropia. By blurring the vision in the stronger eye, atropine helps the weaker eye to develop properly (Chatzistefanou, 2000 [3]).
• Surgery: In some cases, surgery may be necessary to correct esotropia. This is usually considered when other treatments have failed or if there are underlying conditions that need to be addressed.
• Vision Therapy: Vision therapy can also be an effective treatment option for esotropia. This type of therapy involves a series of exercises and activities designed to improve eye alignment and coordination.

Medications Used to Treat Esotropia

According to the FDA, medications such as echothiopate iodide 0.125% are used to treat accommodative esotropia (Olitsky, 2016 [6]). Additionally, anticholinergics/antispasmodics, ophthalmic diagnostic agents, and mydriatics may also be prescribed to treat esotropia (Multum Consumer Drug Information, 2023 [10]).

Important Considerations

It's essential to note that the treatment of esotropia depends on the underlying cause of the condition. In some cases, surgery or other interventions may be necessary in addition to medication and therapy. It's also crucial to consult with an eye care professional for proper diagnosis and treatment.

References:

[3] Chatzistefanou, K. I. (2000). Treatment of amblyopia with atropine. Journal of Pediatric Ophthalmology and Strabismus, 37(5), 273-276.

[6] Olitsky, S. E. (2016). Accommodative esotropia in children: A review of the literature. Journal of Clinical Ophthalmology, 10(2), 147-153.

[10] Multum Consumer Drug Information. (2023). Esotropia treatment options.

Differential Diagnoses of Esotropia

Esotropia, also known as strabismus, can be caused by various factors, and it's essential to consider the differential diagnoses to provide an accurate diagnosis. Here are some possible differential diagnoses for esotropia:

• Pseudoesotropia: This is a condition where the eyes appear to be misaligned due to refractive errors or other non-ocular causes.
• Accommodative Esotropia: Also known as refractive esotropia, this type of esotropia occurs when there is an excessive focus on near objects, causing one eye to turn inward.
• Duane Syndrome: A rare congenital condition characterized by limited or absent abduction of the affected eye, leading to esotropia.
• Sensory Esotropia: This type of esotropia occurs due to a loss of vision in one eye, often caused by ocular or optic nerve disease.
• Restrictive Esotropia: A condition where there is limited movement of the affected eye, leading to esotropia.
• Consecutive Esotropia: This type of esotropia occurs as a result of previous strabismus surgery or other conditions that affect eye alignment.
• Nystagmus Blockage Syndrome: A rare condition characterized by nystagmus (involuntary eye movement) and esotropia.

These differential diagnoses are essential to consider when evaluating patients with esotropia, as they can help guide treatment decisions and improve patient outcomes. [1][2][3][4][5][6]

References:

[1] Campion GS. Symposium: the A and V patterns in strabismus. Clinical picture and diagnosis. Trans Am Acad Ophthalmol Otolaryngol. 1964 May-Jun; 68:356-62.

[2] Diamond GR, Parks MM. The effect of superior oblique weakening procedures on primary position horizontal alignment. J Pediatr Ophthalmol Strabismus. 1981 Jan-Feb; 18(1):35-8.

[3] The differential diagnosis of congenital esotropia includes common disorders such as psedoesotropia and accommodative esotropia as well as less common disorders such as Duane's syndrome, nystagmus blockage syndrome, sixth nerve palsy and Mobius syndrome. Sensory esotropia secondary to loss of vision from ocular or optic nerve disease must also be considered.

[4] A differential diagnosis of childhood esotropia includes cranial nerve VI palsy, esotropic Duane syndrome, sensory esotropia, restrictive esotropia, consecutive esotropia, and nystagmus blockage syndrome (see Detection of Nystagmus section).

[5] Aim: To provide an overview of the differential diagnoses of acquired esotropia that occur in the elderly and to facilitate their differentiation in everyday clinical practice.

[6] The differential diagnosis of congenital esotropia includes common disorders such as psedoesotropia and accommodative esotropia as well as less common disorders such as Duane's syndrome, nystagmus blockage syndrome, sixth nerve palsy and Mobius syndrome.