Person exhibiting esotropia of the right eye

Esotropia is a form of strabismus, or "squint", in which one or both eyes turns inward. The condition can be constantly present, or occur intermittently, and can give the affected individual a "cross-eyed" appearance. Esotropia is sometimed called "lazy eye" in error. This term actually describes the condition of amblyopia - a reduction in vision of one or both eyes which is not the result of any pathological lesion of the visual pathway and which cannot resolved by the use of corrective lenses. Amblyopia can arise as a result of esotropia occurring in childhood. In order to relieve symptoms of diplopia or double vision, the child esotrope will ignore or "suppress" the image from the squinting eye. If this suppression is allowed to continue untreated then amblyopia will develop. Treatment options for esotropia include glasses to correct refractive errors (see accommodative esotropia below), the use of prisms and/or orthoptic exercises and/or eye muscle surgery. The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify diseases and a wide variety of signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or disease. ... The International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10) is a coding of diseases and signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or diseases, as classified by the World Health Organization (WHO). ... // H00-H59 - Diseases of the eye and adnexa (H00-H06) Disorders of eyelid, lacrimal system and orbit (H00) Hordeolum and chalazion (H000) Hordeolum and other deep inflammation of eyelid (H001) Chalazion (H01) Other inflammation of eyelid (H010) Blepharitis (H011) Noninfectious dermatoses of eyelid (H02) Other disorders of eyelid (H020) Entropion... // H00-H59 - Diseases of the eye and adnexa (H00-H06) Disorders of eyelid, lacrimal system and orbit (H00) Hordeolum and chalazion (H000) Hordeolum and other deep inflammation of eyelid (H001) Chalazion (H01) Other inflammation of eyelid (H010) Blepharitis (H011) Noninfectious dermatoses of eyelid (H02) Other disorders of eyelid (H020) Entropion... The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify diseases and a wide variety of signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or disease. ... The following is a list of codes for International Statistical Classification of Diseases and Related Health Problems. ... Image File history File links Download high resolution version (2048x1536, 1111 KB) The photographer has in this case submitted the photo Right Esotropia to the Public Domain File history Legend: (cur) = this is the current file, (del) = delete this old version, (rev) = revert to this old version. ... Image File history File links Download high resolution version (2048x1536, 1111 KB) The photographer has in this case submitted the photo Right Esotropia to the Public Domain File history Legend: (cur) = this is the current file, (del) = delete this old version, (rev) = revert to this old version. ... Strabismus (from Greek: στραβισμός strabismos, from στραβίζειν strabizein to squint, from στραβός strabos squinting, squint-eyed[1]) is a condition in which the eyes are not properly aligned with each other. ... For other uses, see Eye (disambiguation). ... Amblyopia, or lazy eye, is a disorder of the eye. ... Amblyopia, or lazy eye, is a disorder of the eye. ... Diplopia, commonly known as double vision, is the perception of two images from a single object. ... // A refractive error, or refraction error, is an error in the focusing of light by the eye and a frequent reason for reduced visual acuity. ... Look up prism in Wiktionary, the free dictionary. ... Eye surgery in the middle ages. ...

Classification of Esotropia

1. Right, Left or Alternating

Someone with esotropia will squint with either the right or the left eye but never with both eyes simultaneously. In a left esotropia, the left eye 'squints', and in a right esotropia the right eye 'squints'. In an alternating esotropia the patient is able to alternate fixation between their right and left eye so that at one moment the right eye fixates and the left eye turns inward, and at the next the left eye fixates and the right turns inward. Where a patient tends to consistently fix with one eye and squint with the other, the eye that squints is likely to develop some amblyopia. Someone whose squint alternates is very unlikely to develop amblyopia because both eyes will receive equal visual stimulation. It is possible to encourage alternation through the use of occlusion or patching of the 'dominant' or 'fixing' eye to promote the use of the other. Amblyopia, or lazy eye, is a disorder of the eye. ... Amblyopia, or lazy eye, is a disorder of the eye. ...

2. Concomitant versus Incomitant

Esotropias can be concomitant - where the size of the deviation does not vary with direction of gaze - or incomitant - in which the direction of gaze does affect the size, or indeed presence, of the esotropia. The vast majority of esotropias are concomitant and begin early in childhood, typically between the ages of 2 to 4 years. Incomitant esotropias occur both in childhood and adulthood as a result of neurological, mechanical or myogenic problems affecting the muscles controlling eye movements.

3. Primary, Secondary or Consecutive

Concomitant esotropias can arise as an initial problem, in which case they are designated as 'Primary', as a consequence of loss or impairment of vision, in which case they are designated as 'Secondary', or following overcorrection of an initial Exotropia in which case they are described as being 'Consecutive'. The vast majority of esotropias are primary. Person exhibiting exotropia of the right eye Exotropia is a form of strabismus where the eyes are deviated outward. ...

Concomitant Esotropia

Concomitant esotropia can itself be subdivided into esotropias which are constant, and those which are intermittent.

1. Constant Esotropia

A Constant esotropia, as the name implies, is present all the time, with and without glasses, if worn, and at all fixation distances. It may, however have an accommodative element (i.e. be influenced by the exertion of accommodative or 'focusing' effort) when looking at close objects, and this will lead to the esotropia being more noticeable when the affected individual looks at objects close to them.

2. Intermittent Esotropia

Intermittent esotropias, again as the name implies, are not always present: They may be visible when looking at close objects but not when looking at distant ones (Near Esotropia) or, rarely, when looking at distant objects but not at close ones (Distance Esotropia). In very rare cases, they may only occur in repeated cycles of 'one day on, one day off' (Cyclic Esotropia). However, the vast majority of intermittent esotropias are accommodative in origin.

Accommodative Esotropia

Accommodative esotropia is often seen in patients with a moderate amounts of hyperopia. The hyperope, in an attempt to "accommodate" or focus the eyes, converges the eyes as well, as convergence is associated with activation of the accommodation reflex. The over-convergence associated with the extra accommodation required to overcome a hyperopic refractive error can precipitate a loss of binocular control and lead to the development of esotropia. Hyperopia, also known as hypermetropia or colloquially as farsightedness or longsightedness, is a defect of vision caused by an imperfection in the eye (often when the eyeball is too short or when the lens cannot become round enough), causing inability to focus on near objects, and in extreme cases causing... Human eye The Accommodation Reflex is a reflex action of the eye, in response to focusing on a near object, then looking at distant object (and vice versa). ...

The chances of an esotropia developing in these cases will depend to some degree on the amount of hyperopia present. Where the degree of error is small, the child will typically be able to maintain control because the amount of over-accommodation required to produce clear vision is also small. Where the degree of hyperopia is large, the child may not be able to produce clear vision no matter how much extra-accommodation is exerted and thus no incentive exists for the over-accommodation and convergence that can give rise to the onset of esotropia. However, where the degree of error is small enough to allow the child to generate clear vision by over-accommodation, but large enough to disrupt their binocular control, esotropia will result. Hyperopia, also known as hypermetropia or colloquially as farsightedness or longsightedness, is a defect of vision caused by an imperfection in the eye (often when the eyeball is too short or when the lens cannot become round enough), causing inability to focus on near objects, and in extreme cases causing...

Where the esotropia is solely a consequence of uncorrected hyperopic refractive error, providing the child with the correct glasses and ensuring that these are worn all the time, is often enough to control the deviation. In such cases, known as 'Fully Accommodative Esotropias', the esotropia will only be seen when the child removes their glasses. Many adults with childhood esotropias of this type make use of contact lenses to control their 'squint'.

A second type of accommodative esotropia also exists, known as 'Convergence Excess Esotropia'. In this condition the child exerts excessive accommodative convergence relative to their accommodation. Thus, in such cases, even when all underlying hyperopic refractive errors have been corrected, the child will continue to squint when looking at very small objects or reading small print. Even though they are exerting a normal amount of accommodative or 'focusing' effort, the amount of convergence associated with this effort is excessive, thus giving rise to esotropia. In such cases an additional hyperopic correction is often prescribed in the form of bifocal lenses, to reduce the degree of accommodation, and hence convergence, being exerted. Many children will gradually learn to control their esotropias, sometimes with the help of orthoptic exercises. However, others will eventually require extra-ocular muscle surgery to resolve their problems. // A refractive error, or refraction error, is an error in the focusing of light by the eye and a frequent reason for reduced visual acuity. ...

Congenital Esotropia

Congenital esotropia, or [[infantile esotropia]], is a specific sub-type of primary concomitant esotropia. It is a constant esotropia of large and consistent size with onset between birth and six months of age. It is not associated with hyperopia, so the exertion of accommodative effort will not significantly affect the angle of deviation. It is, however, associated with other ocular dysfunctions including oblique muscle over-actions, Dissociated Vertical Deviation (DVD,) Manifest Latent Nystagmus, and defective abduction which develops as a consequence of the infantile esotropes tendency to 'cross fixate'. Cross fixation involves the use of the right eye to look to the left and the left eye to look to the right; a visual pattern which will be 'natural' for the large angle esotrope whose eye is already deviated towards the opposing side. Dissociated Vertical Deviation(DVD) is an ocular condition which occurs in association with a squint, typically Infantile Esotropia. ... Nystagmus is involuntary eye movement that can be part of the vestibulo-ocular reflex (VOR), with the eyes moving first in the direction of the lesioned side (slow phase) followed by a quick correction (fast phase) to the opposite side or away from the lesioned side. ...

The origin of the condition is unknown, and its early onset means that the affected individuals potential for developing binocular vision is limited. The appropriate treatment approach remains a matter of some debate. Some ophthalmologists favour an early surgical approach as offering the best prospect of binocularity whilst others remain unconvinced that the prospects of achieving this result are good enough to justify the increased complexity and risk associated with operating on those under the age of one year.

Incomitant Esotropia

Incomitant esotropias are conditions in whcih the esotropia varies in size with direction of gaze. They can occur in both childhood and adulthood, and arise as a result of neurological, mechanical or myogenic problems. These problems may directly affect the extra-ocular muscles themselves, and may also result from conditions affecting the nerve or blood supply to these muscles or the bony orbital structures surrounding them. Examples of conditions giving rise to an esotropia might include a VIth cranial nerve (or Abducens) palsy, Duane's Syndrome or orbital injury.

Treatment

The prognosis for each esotrope will depend upon the origin and classification of their condition. However, in general, management will take the following course:

1. Identify and treat any underlying systemic condition

2. Prescribe any glasses required and allow the patient time to 'settle into' them.

3. Use occlusion to treat any amblyopia present and encourage alternation. Amblyopia, or lazy eye, is a disorder of the eye. ...

4. Where appropriate, orthoptic exercises can be used to attempt to restore binocularity.

5. Where appropriate, prismatic correction can be used, either temporarily or permanently, to relieve symptoms of double vision.

6. In specific cases, and primarily in adult patients, Botulinum Toxin can be used either as a permanent therapeutic approach, or as a temporary measure to prevent contracture of muscles prior to surgery

7. Where necessary, extra-ocular muscle surgery can be undertaken to improve cosmesis and, on occasion, restore binocularity.

See also

• Infantile esotropia
• Dissociated Vertical Deviation

Infantile esotropia is an ocular condition of early onset in which one or either eye turns inward. ... Dissociated Vertical Deviation(DVD) is an ocular condition which occurs in association with a squint, typically Infantile Esotropia. ...

External links

• What is Esotropia? All Types and Treatments
• FAQs: Eye Muscle Surgery for Esotropia
• British Orthoptic Society Squint Information
• American Association for Paediatric Ophthalmology and Strabismus - Information on Accommodative Esotropia
• Site from East Anglian UK NHS Trust with excellent explanations and photographs of all types of squint.