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Strabismus is a common condition among children in which the eyes are not aligned properly and point in different directions. One eye may look straight ahead, while the other eye turns inward, outward, upward, or downward. The eye turn may be consistent, or it may come and go. Which eye is straight (and which is misaligned) may switch or alternate.

About 4 percent of all children in the United States have strabismus. It can also occur later in life. It may run in families; however, many people with strabismus have no relatives with the problem.

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Accommodative Esotropia

What is Accommodative Esotropia?

Accommodative Esotropia is a focusing type of crossing of the eyes that occurs when children have more farsightedness than usual. Farsightedness is normal in children, and does not affect their vision, because they have special automatic focusing ability, like a "zoom" lens on a camera, that allows them to see clearly for reading and for seeing far away. Children with extra farsightedness can also focus to see clearly, but they have to focus more and in doing so, they often get crossing of the eyes.

How is Accommodative Esotropia treated?

Accommodative Esotropia does not require surgery, but is correctable with glasses to compensate for the farsightedness. When the children wear the glasses, the lenses do the extra focusing for them, and they can see clearly and maintain straight eyes.

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How do glasses keep my child’s eyes from crossing?

In a farsighted child with crossed eyes, glasses are not prescribed to improve vision since eyesight is usually normal. Instead, they are given to relieve the eyes of the need to accommodate. The focusing is now done by the glasses rather than by the eye muscles, and the eyes are allowed to straighten.

Will my child’s eyes always be crossed?

The onset of Accommodative Esotropia can occur from age one to age up until the age of five. What happens after the crossing begins is somewhat like a trip up and over a mountain. The bottom of the mountain is the start of the crossing. As the children grow, they typically will become more farsighted up until the age of six or seven. As this happens, we frequently need to increase the strength of the glasses to help keep the eyes straight. This is the climb UP the mountain. When the children are seven or so, the farsightedness levels off, and, as they grow even more, from the age of eight until twelve, the farsightedness usually decreases. This means we can usually decrease the strength of glasses until they are not needed, usually when the child is ten to twelve years old. Some children may continue to require correction throughout their lives, and may need to wear contacts lenses to control the crossing.

My child is wearing glasses, and his eyes still cross when he takes them off, why?

When your child is wearing the glasses, his eyes will be nice and straight because the glasses are doing all of the"extra" focusing that he needs to see clearly. When he takes the glasses off, or looks over the top of the glasses, he must do the extra focusing himself, resulting in crossed eyes.

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