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

What Causes Esotropia and Exotropia?

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

Types of Esotropia and Exotropia

Both esotropia and exotropia may be congenital (present at birth) or acquired (developed later, during childhood).

Symptoms of Esotropia and Exotropia

Esotropia and exotropia can be intermittent or constant. The most noticeable symptom is one or either eye wandering inward or outward.

How Are Esotropia and Exotropia Diagnosed?

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

Treatments for Esotropia and Exotropia

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: