Accommodative Esotropia: Causes, Symptoms, Diagnosis, and Treatment

What is Accommodative Esotropia?

Accommodative esotropia refers to one or both eyes turning inward when trying to focus. Accommodative esotropia is a type of Strabismus, which is an eye condition in which the eyes are not aligned. According to the American Academy of Ophthalmology, accommodative esotropia is caused by the activation of the accommodative reflex. The accommodative reflex refers to when the eye’s lens shape adjusts to improve focus, particularly in farsighted people. If a person has accommodative esotropia, the eye or eyes will turn inwards when the accommodation reflex is activated. Accommodative esotropia can often be corrected with glasses.

What is the Other Term for Accommodative Esotropia?

There is no other alternative term for accommodative esotropia. However, there are different types of accommodative esotropia including refractive accommodative esotropia and non-refractive esotropia.

What Does Accommodative Esotropia Look Like?

Accommodative esotropia will generally look like one or both eyes are not in alignment with each other, or not facing forwards. For those with accommodative esotropia and esotropia in general, the eye or eyes will turn inwards, towards the nose. When accommodative esotropia is corrected through the use of glasses, the eyes will look aligned and facing forward. The image below shows what uncorrected esotropia looks like with one eye turned inwards towards the nose.

A person with accommodative esotropia, with one eye turned inwards towards the nose.

What are the Different Types of Accommodative Esotropia?

The two main types of accommodative esotropia are refractive accommodative esotropia and non-refractive accommodative esotropia.

Refractive Accommodative Esotropia

Refractive accommodative esotropia refers to accommodative esotropia that is caused by uncorrected hyperopia. Hyperopia is a refractive error in which light entering the eye does not hit the retina properly, leading to issues with near vision. Hyperopia is caused by a misshapen eye, usually a shortness in the length of the eyeball. If a person has hyperopia the eyes will work hard to focus on objects close up, which can lead to the eye or eyes turning inwards with the effort.

Non-Refractive Accommodative Esotropia

Non-refractive accommodative esotropia refers to accommodative esotropia that is caused by excessive convergence of the eyes as they are attempting to accommodate for near focus, regardless of a refractive error, according to the American Academy of Ophthalmology. Non-refractive accommodative esotropia can be treated using bifocal lenses which contain two prescriptions in one lens, separated by a visible line.

What Causes Accommodative Esotropia to Happen?

Accommodative esotropia is generally caused by the activation of the accommodation reflex. According to the American Academy of Ophthalmology, the accommodation reflex refers to the eye’s lens shape adjusting to improve focus. If a person has accommodative esotropia, the eye or eyes will turn inwards when the accommodation reflex is activated. The accommodation reflex can happen in farsighted people, called refractive accommodative esotropia, or regardless of a refractive error, called non-refractive esotropia.

Can Accommodative Esotropia be Caused by Screen Time?

There is no evidence to suggest that screen time can cause accommodative esotropia. However, screen time may trigger the eye or eyes to turn inward as it involves focusing the eyes on near objects. When a person with accommodative esotropia focuses the eyes, known as the accommodation reflex, the eyes have to focus harder than normal to see, which can trigger the eye turn.

A child playing on a tablet screen up close.

How Rare is Accommodative Esotropia?

Accommodative esotropia is not a rare condition, in fact, it is one of the most common forms of strabismus, an eye condition in which the eyes do not align. According to the American Academy of Ophthalmology, accommodative esotropia accounts for one-third of all strabismus cases.

Is Accommodative Esotropia Hereditary?

Yes, accommodative esotropia can be hereditary, as can several types of strabismus. A study by Maconachie GDE, Gottlob I, McLean RJ. called, Risk Factors and Genetics in Common Comitant Strabismus: A Systematic Review of the Literature, posits that there is a strong hereditary link for the development of strabismus, particularly in intermittent and accommodative forms. According to the paper Strabismus genetics across a spectrum of eye misalignment disorders, esotropia in general is likely to have a genetic factor.

Is Accommodative Esotropia a Disability?

No, accommodative esotropia is not generally considered a disability. According to Guide Dogs UK, accommodative esotropia, or strabismus in general, is not usually considered a disability unless it significantly affects a person’s quality of life.

Is Accommodative Esotropia a Disease?

No accommodative esotropia is generally not considered an eye disease, it is an eye condition or vision disorder in which the eye turns inwards as a result of excessive focusing.

How Does Accommodative Esotropia Differ from Other Types of Esotropia?

Accommodative esotropia differs from other types of esotropia in regards to what triggers the eye turn. In the case of accommodative esotropia, the eyes turn inwards due to the activation of the accommodation reflex, when a person is focusing. Other types of esotropia include intermittent esotropia, which refers to esotropia that comes and goes intermittently.

Is Accommodative Esotropia the Most Common Type of Strabismus?

Yes, accommodative esotropia is one of the most common types of strabismus. Accommodative esotropia accounts for one-third of all strabismus cases, according to the American Academy of Ophthalmology.

What are the Signs and Symptoms of Accommodative Esotropia?

The signs and symptoms of accommodative esotropia include esotropia while focusing, diplopia, lazy eye (amblyopia), moderate hyperopia, blurred vision, and depth perception issues. The signs and symptoms of accommodative esotropia are listed below.

Esotropia while focusing: Esotropia while focusing refers to the eye or eyes turning inward when focusing.
Diplopia: Diplopia, also known as double vision, can be a symptom of accommodative esotropia, caused by misalignment of the eyes.
Lazy eye (amblyopia): Lazy eye or amblyopia can be a sign of strabismus, including accommodative esotropia that has not been treated.
Moderate hyperopia: Moderate hyperopia may be a sign of accommodative esotropia.
Blurred vision: Blurred vision can be a symptom of accommodative esotropia, especially if hyperopia is present and a person needs to excessively focus to see clearly.
Depth perception issues: Depth perception issues may be a sign of accommodative esotropia, caused by issues with binocular vision.

1.Esotropia While Focusing

Esotropia while focusing is the main sign that a person has accommodative esotropia. Esotropia refers to one or both eyes turning inwards towards the nose. Esotropia that occurs while a person focuses is a key sign of accommodative esotropia. Focusing activates the accommodative reflex, which can trigger the eyes to turn inward.

2.Diplopia

Diplopia, also known as double vision, is a symptom of accommodative esotropia, caused by the eyes not being in alignment with each other. Diplopia or double vision refers to seeing two images of the same object.

3.Lazy Eye (Amblyopia)

A lazy eye, also known as amblyopia, can be a sign of strabismus, including untreated accommodative esotropia. Amblyopia or lazy eye, refers to reduced or poor vision in one eye due to abnormal vision development. Amblyopia can occur as a result of untreated strabismus as the brain may begin to ignore the images of the weaker eye, according to Kids Health.

4.Moderate Hyperopia

Moderate hyperopia can be a sign that a person has accommodative esotropia. Accommodative esotropia is caused by the activation of the accommodation reflex. The accommodation reflex is the process in which the eye’s lens adjusts to improve focus at near distances, or for eyes that are hyperopic, according to the American Academy of Ophthalmology. If a person has hyperopia, in addition to other symptoms such as eye or eyes that turn inwards, it may indicate that accommodative esotropia is present.

5.Blurred Vision

Blurred vision can be a symptom of accommodative esotropia. Blurred vision may occur as a symptom of accommodative esotropia, particularly refractive accommodative esotropia, if a person isn’t able to accommodate, or has to focus excessively due to hyperopia, according to the American Academy of Ophthalmology.

6.Depth Perception Issues

Depth perception issues can be a symptom of accommodative esotropia due to diminished binocular vision. Depth perception refers to being able to see things in a three-dimensional way. The ability to have good depth perception is largely reliant upon having good binocular vision. Binocular vision is the ability of both eyes to work together to see one image of the same object. If a person has accommodative esotropia, it may diminish their binocular vision, which can in turn affect depth perception. If a person has issues with depth perception, it may impact hand-eye coordination and make activities such as walking up stairs difficult.

How Do Eye Doctors Diagnose Accommodative Esotropia?

Accommodative esotropia will be diagnosed by an optometrist or an eye doctor, known in Australia as an ophthalmologist, through a series of tests including a visual acuity test, a refraction test and a dilated pupil test. An ophthalmologist and an optometrist will be able to diagnose accommodative esotropia, by first asking about a person’s medical and family history, and then conducting a series of eye tests. These eye tests may include a visual acuity test and a refraction test. A visual acuity test assesses the clarity and sharpness of vision and will involve reading letters from a chart on a wall. A refractive test will involve examining the eyes with different corrective lenses to check how light is focused and determine whether vision correction is needed for a refractive error

What are the Differential Diagnoses of Accommodative Esotropia?

The differential diagnoses for accommodative esotropia include infantile esotropia, sixth cranial nerve palsy and pseudoesotropia. A differential diagnosis refers to conditions that share the same symptoms and may be confused with one another. The differential diagnosis of accommodative esotropia is listed below.

Infantile esotropia: Infantile esotropia is a type of esotropia that specifically develops during the first 6 months of life, according to Kaur K and Gurnani B.
Sixth cranial nerve palsy: Sixth cranial nerve palsy is a condition in which there is an issue with the sixth cranial nerve which can lead to issues with the way the eyes move, according to the Cedars Sinai Healthcare Organisation.
Pseudoesotropia: Pseudoesotropia refers to the eyes appearing misaligned, as they would if someone had esotropia, despite being normal. According to the University of Utah’s Moran Core, pseudoesotropia can occur due to orbit size, shape of the eye globe and eyelid anatomy.

How Serious is Accommodative Esotropia?

Accommodative esotropia is not serious as it will not cause blindness and can generally be corrected. However, accommodative esotropia can lead to visual impairment and affect daily life if not treated. If accommodative esotropia is not treated, it can lead to issues with binocular vision, depth perception, blurry vision and double vision which can make everyday activities difficult.

Does Accommodative Esotropia Get Worse?

The signs and symptoms of accommodative esotropia, such as blurred vision, double vision and amblyopia, may get worse if the condition is not treated. However, accommodative esotropia is a highly treatable eye condition and can also get better on its own. According to the American Association for Pediatric Ophthalmology and Strabismus, children with accommodative esotropia may outgrow the condition.

What are the Potential Complications of Accommodative Esotropia?

The potential complications of accommodative esotropia include amblyopia and issues with binocular vision that may lead to diminished depth perception. Amblyopia, also known as lazy eye, may occur if a person has accommodative esotropia as the brain may begin to ignore images from the weaker eye, according to Kids Health. Issues with depth perception are also a potential complication of accommodative esotropia, caused by the way this condition can affect binocular vision. Issues with depth perception can affect a person’s hand-eye coordination which can make everyday tasks difficult.

How Long Does Accommodative Esotropia Last?

The amount of time that accommodative esotropia lasts is generally dependent upon the severity and the treatment of the condition. Some children may outgrow accommodative esotropia over a period of several years. Others may only see improvement in the condition after several months of treatment.

How is Accommodative Esotropia Treated?

The treatment for accommodative esotropia is generally corrective glasses, but can also include surgery. Glasses will be prescribed to a person with accommodative esotropia as the first line of treatment. The purpose of glasses is to help the eyes see better so that the eye or eyes do not turn whilst trying to excessively focus. According to Maidstone and Tunbridge Falls NHS Trust, if an eye turn is not corrected by glasses, then corrective surgery may need to be performed.

How Long Does it Take to Treat Accommodative Esotropia?

The length of time to treat accommodative esotropia is dependent upon the severity of the condition and what treatment is occurring. For those who have been prescribed glasses to treat accommodative esotropia, it may take a few days to a few weeks for the eyes to adjust and full, comfortable correction to be achieved. Eye surgery to treat strabismus will generally take around 40 minutes, according to Health Direct, with people generally able to go home after a few hours and encouraged to take it easy for up to a week.

Can Accommodative Esotropia be Cured Without Surgery?

Yes, accommodative esotropia can be cured without surgery. Glasses or contact lenses are generally used as the first line of treatment for this eye condition, with surgery only used if corrective devices do not work. The eye surgery to treat esotropia is called eye muscle surgery or strabismus surgery and involves making the muscles attached to the surface of the eyeball tighter or looser depending on what is required, according to Health Direct.

Can Glasses Fix Accommodative Esotropia?

Yes, glasses can help to fix accommodative esotropia. Glasses can be used to help correct hyperopia or farsightedness, which will prevent the eyes from excessively focusing to see clearly, which is what activates the accommodation reflex and causes the eyes to turn inwards.

A person with accommodative esotropia without glasses, with their eye turned inwards, next to someone with accommodative esotropia wearing glasses, with the eye facing the front as normal.

Can Accommodative Esotropia Go Away on its Own?

Yes, accommodative esotropia can go away on its own. According to the American Association for Pediatric Ophthalmology and Strabismus, some children may outgrow accommodative esotropia in childhood or adolescence.

Can LASIK Fix Accommodative Esotropia?

LASIK may be a type of surgery that can help to fix accommodative esotropia by reducing the hyperopia refractive error that causes the eyes to excessively focus and leads to an eye turn. LASIK is a type of eye surgery that uses a laser to change the thickness of the cornea, which can improve vision, according to Health Direct. According to a study conducted by Saeed AM, Abdrabbo MA. called, LASIK as an alternative line to treat noncompliant esotropic children, LASIK surgery may be an effective way to treat accommodative esotropia in children by correcting the hyperopia that causes excessive focusing and eye turns. However, LASIK is generally not recommended for those under 18.

What Type of Strabismus Eye Exercise Helps Fix Accommodative Esotropia?

Strabismus eye exercises will not help fix accommodative esotropia, however, they may help strengthen the eye muscles which can help with things such as focus. Pencil push-ups, for example, may help to train the eyes to work together and focus on one point. Pencil push-ups involve holding a pencil at arm's length away from the face, with the top of the pencil at eye level. The arm will then move towards the face, with the goal for the eyes to remain focused on the one point as it gets closer.