Esotropia is a condition in which the eyes are not aligned correctly — instead of working together to focus on the same object, one eye turns inward. This condition can be monocular (involving only one eye) or alternating (where the turning shifts between both eyes).This condition contrasts with exotropia, where the eyes drift outward. Esotropia can be constant (present all the time) or intermittent (appears occasionally). If not treated early in children, esotropia can cause amblyopia, also known as lazy eye, where the brain starts to disregard input from the misaligned eye, hindering normal vision growth.

In adults, this misalignment can cause double vision (diplopia), as the brain struggles to process conflicting images. The root cause is usually related to issues with the muscles or nerves controlling eye movements, preventing both eyes from working in harmony. At Pink City Eye & Retina Center, we emphasize early diagnosis and treatment — such as corrective glasses, vision therapy, or surgery — to realign the eyes and ensure healthy visual development.

Types of Esotropia

Understanding the different types of esotropia helps eye specialists provide the right treatment plan. Below is a comprehensive guide to the different forms of esotropia:

1. Intermittent Esotropia

In this type, the inward turning of the eye doesn’t happen all the time. It may appear occasionally, especially when a person is tired, sick, or trying to focus on something nearby. Vision might still be normal most of the time, but the eye misalignment comes and goes.

2. Constant Esotropia

As the name suggests, this type of esotropia is always present. One or both eyes are constantly turned inward, with no periods of normal alignment. Constant esotropia is more likely to interfere with depth perception and binocular vision.

3. Infantile (Congenital) Esotropia

This condition often develops very early—commonly either at birth or within the baby’s first six months. It is usually a large, noticeable inward eye turn and often requires early surgical treatment. It is not usually linked with the need for glasses.

4. Alternating Esotropia

In alternating esotropia, both eyes are affected — but not at the same time. The inward turn may switch from one eye to the other. This alternating pattern may help preserve some level of binocular vision and can reduce the risk of amblyopia (lazy eye).

5. Accommodative Esotropia

This common type occurs in children who are farsighted (hyperopic). When they try to focus on objects, their eyes strain and turn inward. Often, prescription glasses or contact lenses can correct this condition. In many cases, the alignment improves significantly with the right lenses.

6. Non-Accommodative Esotropia

Unlike accommodative esotropia, this form cannot be corrected with glasses. The misalignment remains even with proper lenses. It may require other treatments such as eye muscle surgery or vision therapy.

7. Pseudoesotropia

This is not a true eye misalignment but only appears like one. Babies with flat nasal bridges and folds of skin at the inner corners of their eyes (epicanthal folds) can give the illusion that their eyes are crossing. However, in pseudoesotropia, the eyes are actually properly aligned.

8. Sensory Esotropia

This occurs when one eye has poor vision due to a disease or injury. Because the eye with weak vision doesn’t contribute properly to binocular vision, it may start to turn inward over time. Treating the underlying vision problem is often the first step.

9. Divergence Insufficiency Esotropia

This type typically affects older adults. It occurs when the eyes have difficulty turning outward (diverging) while looking at distant objects, causing them to drift inward instead. It may lead to double vision when looking far away.

10. Acquired Esotropia

This type of esotropia develops later in life due to causes like neurological issues, trauma, or certain illnesses. It can cause sudden double vision and often needs thorough investigation to find the underlying cause.