Esotropia Accommodative

Crossed eyes from farsighted focusing effort

Overview

Accommodative esotropia is a form of childhood strabismus in which the eyes turn inward because of the focusing effort required to overcome hyperopia, or farsightedness. Accommodation, the change in lens shape for focusing, is neurologically linked to convergence, the inward turning of the eyes, so a hyperopic child who accommodates strongly to see clearly also tends to over converge. It typically begins in the toddler and preschool years, often intermittently at first. In refractive accommodative esotropia, full optical correction of the hyperopia removes the excessive focusing demand and straightens the eyes, and removing the glasses brings the turn back, demonstrating the mechanism. In the nonrefractive or high AC A ratio type, the eyes turn in more at near than at distance, and bifocal lenses are sometimes used. In partially accommodative esotropia, glasses reduce but do not eliminate the turn, and eye muscle surgery may address the residual deviation. Amblyopia is a common association and is treated alongside the misalignment.