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Congenital or infantile esotropia is a type of strabismus which usually appears within the first six months of life although it can be present at birth. In esotropia, the eyes are crossed and while one eye looks straight ahead, the other eye is turned in toward the nose.

During the first months of life the eyes commonly become periodically misaligned, but should the misalignment persist beyond the first few months, you would be advised to contact your optometrist or a pediatric ophthalmologist.

Around two percent of children suffer with congenital esotropia. The cause is unknown, but studies suggest the problem may lie in the brain's inability to coordinate the movement of the eyes.

The treatment for congenital esotropia usually will require eye muscle surgery. But before the surgery is performed, there are other factors to consider. If amblyopia (decreased vision in one or both eyes) has developed in one eye, this poor vision must be treated immediately. This is done by patching the better eye and forcing the brain to use the eye with poor vision. This won't correct the eye crossing but it will equalize vision and contribute towards successful surgery.

Although uncommon, far-sightedness also is a factor and eyeglasses must be tried to maybe diminish the eye crossing.

Congenital or infantile esotropia cannot be outgrown and surgical attention is recommended usually between six and nine months.

The reasons for correction are more than cosmetic. Eye misalignment in childhood can result in the inability of the brain to use the two eyes together, causing binocular vision. The early correction will help the brain to experience normal depth perception and fine 3-dimensional vision. Achieving this at an early age will afford a child the best chance of maintaining early ocular alignment throughout life.

Periodic follow-up is necessary after surgery to detect associated eye problems. Not all surgery will turn out to be successful, and vertical misalignments of the eye, particularly when looking to the side (see photo below), recurrent eye crossing and amblyopia may occur months, years or decades after successful eye muscle surgery.

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