This refers to a crossing of the eyes (“esotropia”) caused by farsightedness. Children who are farsighted easily and automatically focus on objects at distance and near through “accommodation”. Accommodation refers to the contraction of a small muscle inside the eye to cause the natural lens in the eye to change its shape and allow images to focus properly on the back surface of the eye. As a result, a child who is farsighted usually does not have blurred vision. However, in some children who are farsighted, this accommodative effort is associated with a reflex crossing of the eyes. Hence the term, “accommodative esotropia”.

Accommodative esotropia can begin anywhere from 4 months to 6 years of age. The usual age of onset is between 2 and 3 years of age.

A noticeable crossing of the eyes is usually the primary sign. This crossing may only be evident when your child views a near object or when your child is tired or not feeling well. Some children will complain of double vision or may be seen squinting or rubbing one of the eyes.

Diagnosis and Treatment

The Paediatric Ophthalmologist will perform all of the necessary tests to confirm that your child has an accommodative esotropia. This includes an examination with dilating eye drops to determine the degree of farsightedness and to make sure the eyes are otherwise normal.

Full-time use of the appropriate farsighted glasses will often control the esotropia. When wearing the glasses, your child will not need to accommodate and hence the associated eye crossing reflex will disappear. However, after removing the glasses, the crossing will reappear, perhaps even more than before your child began wearing glasses.

Sometimes the glasses will only cause the crossing to disappear when your child looks in the distance. However, when gazing at near objects, crossing may persist despite the use of the glasses (Partiallly Accomodative Esotropia). In these circumstances, a bifocal lens is usually prescribed to permit your child to have straight eyes at all viewing distances.

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