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Accommodative esotropia is crossing of the eyes caused by far-sightedness. Accommodation refers to a small muscle inside the eye that contracts to cause the eye's natural lens to change shape and allow images to focus properly on the retina. But in children who are far-sighted, this accommodative function is associated with a reflex crossing of the eyes. Accommodative esotropia occurs in children between the ages of 4 months and 6 years but commonly occurs mostly between the ages of 2 and 3.

What are the Symptoms of Accommodative Esotropia?

Crossing of the eyes is the most marked symptom. It may be noticeable though only when your child looks intently at something close up or when tired or feeling unwell. Some children may complain of double vision or may squint and rub one of the eyes.

How is Accommodative Esotropia treated?

Once the pediatric ophthalmologist has confirmed your child has accommodative esotropia, full-time use of far-sighted eyeglasses often will control the esotropia. But when the eyeglasses are removed, the eye crossing will return, possibly worse than when your child began wearing them.

Sometimes the eyeglasses may only be effective in correcting the crossing when your child looks into the distance. The crossing may persist despite the use of glasses when your child looks at near objects. Should this occur, a bifocal lens usually is prescribed to allow your child to have correct eye alignment at all viewing distances.

What about Surgery?

If eyeglasses are successful in controlling eye crossing then eye muscle surgery is not a recommendation. Should the eye crossing be noticeably evident despite the eyeglasses then eye muscle surgery can be considered.

What is the prognosis?

The far-sightedness is likely to increase slowly until around the age of eight years. Thereafter it will diminish each year and many children will maintain proper eye alignment without glasses in their early teens. Some children, however, may not need glasses at an early age, while others will find it necessary to wear them, or contact lenses, even into adulthood.

The pediatric ophthalmologist's focus is to constantly try weaning a child from being dependent on glasses.


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