Accommodative Esotropia

Most children are farsighted. In children, this means that they can see well at both distance and at near. However, they have to “focus” or accommodate to do so. This is usually not a problem as children have a very large “focusing” ability. A reflex exists that make the eyes want to cross when we try to focus. This normal reflex allows our eyes to maintain alignment when we focus to read material close to us, i.e. our eyes must both turn in a little to work together at near. However, if a child is very farsighted, his eyes may cross when he focuses to see well. In this case, he must make a subconscious decision to see well or cross his eyes.

The treatment for this type of strabismus is glasses. The child is given glasses to correct his farsightedness. Because he no longer has to focus to see well, he will no longer cross his eyes with the glasses. If glasses do not straighten the eyes, sometimes surgery is needed. Amblyopia is very common in this setting. If amblyopia is present, treatment for this, in addition to the glasses, may be required. Treatment sometimes involves patching or eye drops. Many children lose some of their farsightedness as they get older and will outgrow their glasses. This is dependent on the initial level of farsightedness and the growth curve of the eye. It is very individualized and therefore it is hard to predict who will outgrow their need for glasses.

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