Prepared by Scott E. Silverman, M.D.
Pediatric Ophthalmologist

What causes accommodative esotropia?
Esotropia means crossing of the eyes. Accommodative means that the crossing is due to focusing of the eyes. Children with accommodative esotropia are usually farsighted. That means they can see clearly only with extreme focusing of the lenses inside their eyes. The brain's control over focusing and crossing are linked. Focusing is linked to crossing much like peddling a bicycle turns the wheels. In order for your child to see clearly, extreme focusing takes place which causes their eyes to cross.

How is accommodative esotropia treated?
Accommodative esotropia is treated with glasses and sometimes surgery. Some children do well with single vision glasses. Other children require bifocal glasses. The glasses allow your child to see clearly without extreme focusing of their eyes. When their eyes do not have to focus, then the link to crossing is cured! In the majority of children, glasses completely eliminate the problem.

When the glasses are in place, your child's eyes should not cross. Whenever the glasses are taken off, their eyes may cross. It is important for you to realize that the glasses help your child to see clearly and without them, your child has to strain to see. The glasses relieve the need to focus which causes the eyes to cross. It is not caused by reading in dim lights or sitting close to the television.

In some children, glasses only partially improve the crossing. In these children, eye muscle surgery is needed to align the eyes. If this becomes necessary, the details of surgery will be carefully explained.

Are there any special tricks to get my child used to wearing the glasses?
The best start is with support and encouragement. Safety straps are useful. Your child may honestly tell you that he/she does not see any better or that vision is initially worse with the glasses on. This is because your child has not yet relaxed the focusing muscles in their eyes. If your child continues to complain of blurry vision with the glasses on, drops can be prescribed to help adjust to the glasses. The glasses should be worn during all waking hours. This means that they should be removed at night, but they do not necessarily have to be removed during naps. When they are removed at bath or bed time, you may notice the eyes cross.

How long will glasses be needed?
Your child may outgrow farsightedness and crossing of the eyes. Farsightedness naturally decreases as a child grows. As this happens, the strength of the glasses will be decreased. Eventually, many children outgrow the need for bifocals or glasses. Other children need glasses or contact lenses for life.