Infantile esotropia

This is a form of strabismus which occurs during infancy. For many years the term "congenital esotropia" had prevailed, but the disease is rarely present at birth. Normally, it occurs several months after, and for this reason it is preferable to refer to it as "infantile esotropia" or even better (due to the unknown cause of it) idiopathic infantile esotropia.

It usually occurs in babies with cerebral palsy, hydrocephalus or delayed development and rarely in children who are otherwise healthy. So far, it has not been associated with a gene and we do not know exactly what causes it. In almost all cases, the angle of strabismus is quite large and easily recognizable by the parents before the 6th month of life.

Many children with infantile esotropia, focalize with one eye and sometimes with the other, and this is very positive because it is giving both eyes the chance to grow equally in the critical first year of life. The rest of the children though, who prefer to use one eye than two, end up experiencing amblyopia in the eye which is not used.

The treatment of infantile esotropia
The treatment of infantile esotropia begins with the covering of the "good" eye, in order to give the opportunity to the weaker eye to develop its vision and prevent amblyopia. Once vision has been equilibrated between the two eyes, the treatment of infantile esotropia is surgery. It is  generally considered preferable to operate on both eyes dividing the amount of correction, than operate on the entire range of the derogation only in one eye.

A subject of disagreement amongst ophthalmologists is the “right age“ to have surgery. While others prefer to wait, many argue that surgery should be done between the ages of 6 and 18 months, which is more likely for a child to develop some degree of binocular vision.

After surgery, many parents report a sharp increase in the mental status of the child who seems to be more interested in its environment than
before and may even have developed some new skills. This shows us how important vision is for the proper development of a child in their first years of life.

More than half of the children who were operated for the correction of infantile esotropia won’t be needing again such surgery.
Even though they learn to use both their eyes collaboratively, they will never have the same stereoscopic ability as children who had never had strabismus. They may not have the degree of stereopsis that some demanding occupations, such as Fighter pilot need, but their stereoscopic capacity will be enough to not face any problems in all the other activities of their life.

In other children, the eyes do not remain aligned and after a few months or years strabismus may reappear. Usually it is adaptive esotropia (see the following chapter), which is corrected with glasses, although in some cases another surgery cannot be prevented. More rarely, strabismus returns in the form of exotropia, which also requires surgical treatment.

Pseudoesotropia

Various conditions may lead to the impression of strabismus, when in fact there is no deviation. Especially in neonates and infants, the broad basis their nose, can give the impression of esotropia due to the partial coverage of the sclera (the "white" part of the eye).
The impression is even more pronounced if the cover is asymmetrical and leaves less of the "white part" of the eye from the one side. But if we light a lens-pen in front of the child's face and carefully observe the corneal reflections, we will see that they are at the center of the pupils in both eyes, which means that the eyes are aligned.

With the advancing of age, the child's head grows, his eyes move away from each other, his nose grows removing the skin covering the sclera, and the phenomenon is eliminated.

Due to the frequent occurrence of pseudoesotropia, it has spread amongst parents that esotropia in infancy, is improved by itself as time passes.

Such misunderstandings can lead to a delay in treatment of a real case of esotropia, for that reason all cases must be checked.