Congenital (infantile) esotropia is a type of strabismus which generally appears within the first six months of life. This esotropia may be present at birth but often develops within the first few months. In the first months of life, it is common for the eyes to intermittently become misaligned. If a misalignment of the eyes persists after the first few months, a consultation with a paediatric ophthalmologist is required

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Treatment of congenital esotropia usually requires eye muscle surgery.Before surgery is performed, various factors must be considered. If amblyopia has developed in one eye, the poor vision must be treated first by patching the better eye to force the brain to use the eye with poorer vision. Though this will not correct the eye crossing, it will equalize the vision which improves the prognosis for a successful outcome from surgery. The presence of farsightedness or need of glasses must also be detected prior to an operation. Though this is an uncommon cause of esotropia in infants, glasses must be tried when there is significant farsightedness present as glasses, alone may diminish the eye crossing.

Surgical correction is usually recommended between six and nine months of age. The reasons for correction go beyond the obvious drastic improvement in the child’s appearance. When the eyes are misaligned in childhood, binocular vision, or the ability of the brain to use the two eyes together, does not develop. Early alignment of the eyes allows for the development of the brain’s ability to experience normal depth perception and fine 3-dimensional vision. Achieving this binocularity at a young age will also afford a child the best chance of maintaining normal ocular alignment throughout life. Additionally, a child with good ocular alignment is at decreased risk for developing amblyopia.

Even after successful surgery, periodic follow-up is necessary to detect associated eye problems. Vertical misalignments of the eye, especially when looking to the side (see photo below), recurrent eye crossing and amblyopia may occur months, years or decades after successful eye muscle surgery.

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