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Pediatric Esotropia and Exotropia

What are esotropia and exotropia?

Esotropia and exotropia are types of strabismus, which is a condition in which the eyes are not properly aligned. Esotropia means that one eye is deviated inward and is often called crossed eyes. Exotropia is when one or both eyes look outward, often called wall-eyed.

Although newborns' eyes may wander or cross sometimes, the eyes usually straighten by 2 to 3 months of age. If the condition continues and is left untreated, it can lead to:

"Lazy eye" (amblyopia): Inability of one eye to see well (in spite of glasses or other means)
Vision problems including loss of depth perception or 3-dimensional vision

Causes of esotropia and exotropia are mostly unknown. Children with a family history of the disorder are more likely to get them. They are also common in children who have other systemic (chromosomal or neurologic) disorders.
- No known cause (idiopathic); possibly familial
- Down syndrome
- Cerebral palsy
- Hydrocephalus (Increased intra-cranial pressure)
- Brain tumors
- Trauma
Both esotropia and exotropia may be congenital (present at birth) or acquired (developed later, during childhood).
Esotropia and exotropia can be intermittent or constant. The most noticeable symptom is one or either eye wandering inward or outward.
You or your child's pediatrician may notice that your child's eyes are not straight. At Children's National, we emphasize the need for a pediatrician's vision and ocular alignment screening at regular well-baby visits. When in doubt, your pediatrician will refer your child to an ophthalmologist for a comprehensive eye evaluation. If there is family history of pediatric eye diseases, we recommend an early comprehensive eye examination.
Your child's pediatrician may recommend further testing as follows:
- Diagnostic imaging, including MRI scans, to determine whether the eye misalignment is being caused by nerve, rather than muscle, problems
- Genetic studies to detect chromosomal problems that may indicate genetic syndromes
Treatment for esotropia and exotropia aims to ensure proper vision in both eyes and straighten the eyes. Among the treatment options for esotropia are:
- Glasses to correct vision problems such as nearsightedness, farsightedness or astigmatism
- Patching of the good eye, to improve vision in the lazy (amblyopic) eye
- Surgery on the eye muscles to realign the eyes
Treatment options for children with exotropia include:
- Glasses
- Exercises or an eye patch over the strong eye to strengthen vision in the weak eye
- Surgery on the eye muscles