What are the other Names for this Condition? (Also known as/Synonyms)

• Refractive Esotropia

What is Accommodative Esotropia? (Definition/Background Information)

• Accommodative Esotropia is reportedly amongst the most common form of pediatric strabismus. Esotropia is a form of strabismus (or crossed eye), an eye condition in which both eyes cannot simultaneously focus on the same place
• It often becomes evident when a child is engaged in activities that require near vision, such as reading or drawing. Accommodative Esotropia often develops in infancy or early childhood when the child starts engaging in activities that demand close-up focus
• Accommodative Esotropia is also known as Refractive Esotropia. This form of eye misalignment is more often seen in individuals with farsightedness (hyperopia). Since the eye must work harder (due to esotropia and hyperopia) to focus clearly, particularly on nearer objects, the term “accommodative” is used
• Regular eye examinations by an ophthalmologist are crucial for early detection and management of Accommodative Esotropia. Timely intervention, often with the use of glasses, can help improve eye alignment and prevent long-term visual complications. The condition may change as a child grows, and ongoing monitoring and adjustments to the treatment plan may be necessary

Who gets Accommodative Esotropia? (Age and Sex Distribution)

• According to reports, around 1-2% of the general population present Accommodative Esotropia
• Individuals in any age category may be affected
• Most cases are noted in children between 2-4 years of age; some children develop the condition either in early infancy or into late childhood
• Both males and females may be affected
• Worldwide, individuals of all races and ethnicities are prone to developing the condition

What are the Risk Factors for Accommodative Esotropia? (Predisposing Factors)

The risk factors for Accommodative Esotropia may include:

• Moderate to severe longsightedness (hyperopia)
• An injury to the eye or illness may be noted before the development of Accommodative Esotropia; however, these are not known to be causative
• A family history of the condition may be a risk factor

It is important to note that having a risk factor does not mean one will get the condition. A risk factor increases one’s chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Accommodative Esotropia? (Etiology)

Accommodative Esotropia is a type of strabismus (misalignment of the eyes) that typically occurs in children. This condition is characterized by the inward turning of one or both eyes and is associated with the effort to focus on close objects.

• Accommodative Esotropia often arises due to the natural focusing process associated with farsightedness
• In infancy, as a child's eyesight develops and they learn to focus on objects, the eye muscles may not coordinate perfectly
• This lack of coordination can lead to the eyes turning inward, causing esotropia

It is important to note that not all children with long-sightedness develop Accommodative Esotropia. Also, those with mild forms of long-sightedness are not known to present the condition.

What are the Signs and Symptoms of Accommodative Esotropia?

The signs and symptoms of Accommodative Esotropia may vary from one individual to another in severity. These may include:

• Crossed eye
• Blurred vision
• Double vision
  • Double vision is more often seen in the peripheral vision than in central vision
  • Binocularity in vision can be seen in nearly 70% of the individuals
  • Binocularity refers to the ability of the eyes to work together for vision
• Presence of longsightedness

How is Accommodative Esotropia Diagnosed?

The following observations and tests may help diagnose Accommodative Esotropia:

• Physical examination and medical history evaluation
• Assessment of signs and symptoms
• General eye exam
• Visual acuity test using a unique and standardized test chart (Snellen chart)
• Slit-lamp examination

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Accommodative Esotropia?

The complications of Accommodative Esotropia may include:

• Worsening of the eye condition leading to poor vision (loss of binocular vision), particularly in the absence of treatment or due to delayed treatment
• Onset of amblyopia (lazy eye)
• Decreased quality of life

How is Accommodative Esotropia Treated?

• The initial treatment for Accommodative Esotropia involves prescription eyeglasses (spectacles)
• If eyeglasses are not helpful and the condition is severe, some children may require a surgical correction
• Surgery may be of the following types:
  • Strabismus surgery
  • Refractive surgery (LASIK): This is typically performed in individuals over the age of 18 years when they do not outgrow their eyeglasses

How can Accommodative Esotropia be Prevented?

Currently, there are no methods to prevent Accommodative Esotropia. However, it is vital to maintain close/periodic follow-up.

What is the Prognosis of Accommodative Esotropia? (Outcomes/Resolutions)

The prognosis of Accommodative Esotropia is generally good in children who outgrow the condition (mostly during adolescence).

• Children who do not outgrow the condition may need to wear eyeglasses for their lifetime. Also, some children who undergo surgery may still need to use eyeglasses
• The severity of the condition may be difficult to predict in some children; only as the child grows will the magnitude of the condition become apparent. Thus, an early diagnosis and adequate management of the condition is critical

With early intervention and appropriate treatment approaches, the depth perception of vision can be preserved in a significant number of patients with Accommodative Esotropia. Therefore, a high level of stereopsis, which is the ability to perceive depth and three-dimensionality, is maintained in approximately 25% of the patients if early treatment for esotropia is considered before bifocals usage or surgery.

Additional and Relevant Useful Information for Accommodative Esotropia:

The following DoveMed website link is a helpful resource for additional information:

https://www.dovemed.com/diseases-conditions/amblyopia