Your child has a condition Ophthalmologists classify as infantile esotropia. This term describes crossing of the eyes occurring very early in life. Infantile esotropia is not the result of “bad muscles”; it is the result of inappropriate messages sent from the brain centers that control eye movements. These centers are deep in the brain and are not accessible. The inappropriate messages sent from these centers may produce now or at sometime in the future some or all of the following:
Crossed eyes.
A tendency to look to the right with the left eye and to look to the left with the right eye. (Cross-fixing).
Limited or apparent limited ability to turn either eye far away from the nose.
Involuntary wheel or back-and-forth movements of the eyes. (Nystagmus).
Unusual head positions (head tilted to the right side, to left side, with chin up, down or straight). These head positions are achieved by the child to minimize the involuntary movements of the eyes.
An overaction of the muscles that turn the eyes upward on side-gaze.
A tendency of either or both eyes to float upward (this may not be obvious until after the horizontal misalignment is substantially reduced).
At age 3-5 years, effort-produced crossing of the eyes. (Crossing requiring eyeglasses for treatment).
Treatment
When a significant need for glasses or a strong preference for one eye is found, medication, glasses, patching or a combination of these may be tried. Rarely does this condition respond to non-surgical measures. Surgery is usually required. This is done by repositioning various muscles. Almost half the children with this condition require more than one operation.
Goals of treatment
The ultimate goal is to place the eyes in a position where a type of cooperative simultaneous use of the eyes can occur (binocular vision). This can de achieved when the eyes are within five degrees of perfect alignment. We try to put your child’s eyes as straight as possible with the least intervention, all the time striving to maintain good vision in each eye.
Course
A typical course for a child with infantile esotropia would be to have surgery early in life achieving a desirable position and maintaining that position. That child would need no further surgery. Another child with infantile esotropia might respond differently to the same treatment. There may be an inadequate alignment after surgery. That child would need additional surgery. Another course encountered after operation is a child with an immediate postoperative position that is very satisfactory deteriorating months or years later to a position that is not satisfactory.
Summary:
Your child has a complex, though not serious problem. We can measure with reasonable accuracy the angles of deviation. We cannot predict each individual’s response to accepted surgical treatment. The treatment modifies the defect. After surgery is performed, the eye position stabilizes over some 6-12 weeks. Then if the eyes are in an unsatisfactory position, additional surgery may be advised.
American Academy of Ophthalmology
The Eye M.D Association