More than half of strabismus cases in children fall under esotropia, making it the most common type of squint. The incidence is about 1% over 10 years for patients under 19 years of age. The average presenting age of accommodative esotropia is 2.5 years, although there is a wide range from 3 months to 7 years, depending on the type of esotropia.

The goals of treatment are to:

About 20 to 40% of patients with esotropia will also have amblyopia in the “weaker” eye. The aim of the treatment is to encourage the weaker eye to start stimulating the brain again, which results in improved vision in that eye over time. The most effective way to do this is to “limit” the vision in the better eye for a specified number of weeks or months, as determined by the specialist. The main goal is not to straighten the eyes but to restore vision. Patching is one of the methods to do this. An adhesive patch covers the eye with the better vision. This occludes the “stronger” eye forcing the brain to recognise the “weaker” eye again. A blurring lens can be placed over the “good” eye or drops can be administered that blur vision in the “good” eye. The first option is usually the most practical treatment, but its success depends on the compliance of both parents and child. If the amblyopia is treated successfully the child will no longer favour the “stronger” or dominant eye but will happily alternate gaze from one eye to the other.

This is done via two methods; glasses and or surgery and the aim is to get the eyes as straight as possible as soon as possible.

Children, even very young children, adjust quite well to glasses. The glasses not only straighten the eyes, but also relax the child’s ability to over-focus. This helps alleviate symptoms associated with eyestrain. For patients with accommodative esotropia, glasses must be worn full-time. Older children over 4 to 5 years, may have blurred distance vision when they first put on their glasses. This is because they have a strong habit of over-focusing and continue to do so even when wearing glasses. Over several days, most children will relax their eyes and adjust well. The eyes usually straighten within a few days to a few weeks. If the eyes are still crossing and not working together as a team after this period, eye muscle surgery is usually required. Those whose squint is fully corrected, don’t tend to develop amblyopia and have an excellent chance of stereopsis. If the squint’s angle is partially corrected, the child will require surgery in addition to wearing glasses. With near esotropia, glasses will straighten the eyes for distant objects, but the eyes will still cross for near objects. Bifocal glasses can help. This is a small powerful lens placed in the lower part of the child’s glasses. This lens further relaxes “extra” focusing to straighten the eyes for near objects. Chin-up posturing indicates that the child is looking through the lower bifocal lens for near work, therefore using them correctly.

This is required if the eyes are not straightened using conservative measure like patching or wearing glasses. The eye specialist will take very specific and accurate measurements during the various consultations to ensure that the surgery they perform is matched to the child’s condition perfectly. There are 6 eye muscles that are responsible for moving each eye. Surgery for esotropia involves detaching one or more of these muscles from the eyeball and then reattaching them to a new location on the eye so that the muscles will work in the right way to help the eye to see straight. When both eyes are affected, both eyes require surgery.