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Esotropia describes an inward turning eye and is
Exotropia is a type of strabimus or eye
the most common type of strabismus in infants. 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 pediatric ophthalmologist is
required. Twins are rarely both affected. Siblings are
rarely affected with clinically apparent congenital
ET. In contrast refractive esotropia is more
commonly seen as a family, genetic trait. Young
children with esotropia do not use their eyes
together. In most cases, early surgery to align the
eyes is needed to obtain binocular vision and
prevent permanent vision loss.
"Accommodative esotropia" is a common form of
esotropia which occurs in farsighted children,
usually two years old or older. When a child is
young, they can focus their eyes to adjust for the
farsightedness but the focusing effort
(accommodation) required to see clearly stimulates
the eyes to cross. Glasses reduce the focusing effort
and can straighten the eyes. Sometimes bifocals
are necessary for close work. Eye drops, ointment or
special lenses called prisms can also be used to
straighten the eyes. Eye exercises occasionally help
older children.
misalignment. Exotropia refers to an outward
deviation of the eyes. Although Exotropia
commonly begins around age 2 to 4 years, it can
appear at any age.
What About Eye Patches And Glasses?
It is not uncommon that children with any form of
strabismus (including exotropia) will have
decreased vision in one eye. This is known as
"amblyopia". If there is a significant amblyopia
present, the pediatric ophthalmologist will prescribe
the appropriate eye patch to be worn over the
stronger eye to force your child to use and
strengthen the eye with amblyopia. If your child
has a need for eyeglasses, they will be prescribed
as well.
Aside from the obvious improvement in your child's
appearance when misaligned eyes are corrected,
there are other functional benefits to consider.
When a significant ocular misalignment exists in
childhood, the brain's developing visual system
does not acquire binocular vision. Aside from
improved depth perception, a person with
binocular vision tends to maintain good ocular
alignment throughout life. Additionally, a child with
good ocular alignment is at decreased risk for
developing amblyopia.
Treatment:
1.
2.
3.
4.
5.
6.
Correction of refractive status
Overcorrecting minus lens
Patching
Amblyopia treatment
Prism therapy
Convergence exercises for
convergence insufficiency
7. Extraocular muscle surgery
The eye muscle surgery is generally not
recommended until the vision in each eye is
maximized with either patching therapy and/or
eyeglasses when appropriate. In some children, the
exotropia can improve with only these measures
and an operation may become unnecessary.
Pediatric Ophthalmic Consultants
http://www.pedseye.com/strabismus_esotropia.htm
Richmond Eye Associates, P.C.
http://www.richmondeye.com/eyemotil.asp
ScienceDaily
http://www.sciencedaily.com/releases/2009/06/090608162436.ht
m
American Academy of Ophthalmogy
http://one.aao.org/ce/default.aspx
Cyber-Sight Orbis Telemedicine
http://www.cybersight.org/bins/volume_page.asp?cid=1-3-4-16
Eyerobics http://www.eyerobics.com.au/exotropia.html
National Guideline Clearinghouse
http://www.guideline.gov/content.aspx?id=11752
Strabisimus.org
www.strabismus.org/exotropia_eye_turns_out.html
University of Michigan Kellogg Eye Center
http://www.kellogg.umich.edu/patientcare/conditions/esotropi
a.html