Seeing your child with crossed eyes or eyes that seem to wander outward can be a cause for concern. These conditions are known as esotropia and exotropia, which are types of strabismus 一 a misalignment of the eyes that prevents them from working together effectively. 

While it’s normal for newborns’ eyes to wander occasionally, persistent misalignment in older infants and children can affect vision development. 

This informative blog post will delve into pediatric esotropia and exotropia, helping you understand the causes, symptoms, and treatment options available.

What is pediatric esotropia and exotropia?

Pediatric esotropia and exotropia are types of strabismus, a condition where the eyes are misaligned. Here’s a brief overview of esotropia and exotropia:

  • Esotropia

Often referred to as “crossed eyes,” esotropia is a condition where one or both eyes turn inward towards the nose. This inward turning can be constant or intermittent, meaning it comes and goes. 

Esotropia can interfere with the brain’s ability to blend the images from each eye, leading to double vision, or to the brain favoring one eye and the other eye losing vision.

  • Exotropia

Exotropia is when one or both eyes turn outward, sometimes referred to as “wall-eyed” or “lazy eye.” Similar to esotropia, exotropia can be constant or intermittent and affect near, distance, or both types of vision.

Exotropia can cause double vision and might also make it difficult to focus when looking at objects that are near.  It can also lead to permanently decreased vision.

While strabismus can occur at any age, esotropia, and exotropia are specifically associated with infants and children. If left untreated, it can lead to amblyopia (lazy eye), where the vision in the misaligned eye doesn’t develop properly.

What are its common causes?

The exact cause of esotropia and exotropia can vary depending on the type and severity. Here’s a breakdown of some common causes:

  1. Muscle imbalance

The six muscles surrounding each eye control its movement. An imbalance in the strength or coordination of these muscles can lead to misalignment.

  1. Focus problems

Difficulty focusing on near objects or maintaining focus can sometimes contribute to esotropia.

  1. Farsightedness

Farsightedness, a refractive error where distant objects are seen clearly but near objects are blurry, can be a risk factor for esotropia in some children.

  1. Certain medical conditions

Occasionally, strabismus can be associated with underlying medical conditions such as Down syndrome, cerebral palsy, tumors, as well as many other conditions.

  1. Family history

Children with a family history of strabismus are more likely to develop the condition.

What are the key symptoms of esotropia and exotropia?

Early detection of esotropia or exotropia is crucial for optimal vision development. 

Here are some signs to watch for in your child:

  • Eye turning: The most obvious sign is an inward or outward turn of one or both eyes.
  • Head tilting: Your child may tilt their head in an attempt to improve their vision by aligning their eyes.
  • Squinting: Squinting can be a sign that your child is trying to overcome double vision caused by strabismus.
  • Poor depth perception: Difficulty judging distances can indicate vision problems caused by strabismus.
  • Frequent eye rubbing: This could indicate eye strain or discomfort caused by misalignment.

It’s important to note that occasional eye turning is common in newborns. However, if you notice any of these signs persisting beyond three months of age, it’s essential to consult a pediatric ophthalmologist immediately. 

During a comprehensive eye exam, a pediatric ophthalmologist will assess your child’s vision, eye alignment, and overall eye health. The doctor may use various tools, including a cover test, retinoscopy, and other equipment, to evaluate the eyes.

What are the treatment options for esotropia and exotropia?

The treatment options for esotropia and exotropia are aimed at correcting eye alignment, strengthening the weaker eye, and preventing vision problems like amblyopia. Some examples of treatment approaches include:

  1. Eyeglasses

Eyeglasses help correct underlying refractive errors like farsightedness, which can contribute to esotropia.

  1. Patching therapy

Patching the stronger eye encourages the weaker eye to work harder, improving its vision and strengthening eye muscles.

  1. Eye exercises

Orthoptic exercises can help improve eye muscle coordination and control. These are particularly useful for certain types of exotropia, such as convergence insufficiency.

  1. Eye drops or injections

In some cases, medications like eye drops or botulinum toxin (Botox) injections can be used to temporarily weaken specific eye muscles, helping with alignment.

  1. Eye muscle surgery

When non-surgical options prove insufficient, eye muscle surgery may be recommended. This procedure involves adjusting the length or position of the muscles and controlling eye movement to correct the misalignment.

How can I support my child with esotropia or exotropia?

If your child has been diagnosed with esotropia or exotropia, you might be feeling overwhelmed or unsure how to best support them. Here are some practical strategies to support your child as they go through with this condition:

Follow the treatment plan

Be diligent with prescribed treatments like patching therapy or eye exercises. Consistency is vital in helping your child achieve improved eye alignment and vision.

Offer encouragement

Talk to your child about their eye condition and the treatment process. Be positive, reassuring, and offer praise for their cooperation with treatments.

Minimize self-consciousness

If your child is old enough to be concerned about their appearance, address their fears directly. Reassure them that their eyes can improve with treatment and that the condition doesn’t define them. If they wear a patch or glasses, help them choose ones they feel good about.

Advocate for your child.

Communicate openly with your child’s doctors, teachers, and caregivers. Ensure everyone involved understands your child’s needs and potential challenges, such as difficulty reading due to the condition.

Be informed

Learn as much as you can about esotropia and exotropia. This will help you explain things to your child and others as needed.

Find a support network.

If possible, connect with other families or support groups for parents of children with strabismus. Having a community that understands the experience can be comforting and empowering.

Pediatric Eye Associates: Your Child’s Vision Experts

Pediatric Eye Associates understands the unique visual needs of children and adolescents.  Our board-certified pediatric ophthalmologists are dedicated to providing comprehensive eye care in a compassionate environment tailored to young patients.  

From routine eye exams to the management of complex eye diseases, Pediatric Eye Associates delivers exceptional care for your child’s most precious senses. 

We prioritize clear communication, offering thorough explanations and personalized treatment plans to optimize your child’s visual health.

Entrust your child’s vision to the specialists at Pediatric Eye Associates. Contact us today to schedule a consultation with a pediatric eye doctor.

The material contained on this site is for informational purposes only and DOES NOT CONSTITUTE THE PROVIDING OF MEDICAL ADVICE, and is not intended to be a substitute for independent professional medical judgment, advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified healthcare providers with any questions or concerns you may have regarding your health.