| Accommodative esotropia begins suddenly between the ages of eighteen months and four years. | |
| 39. | Prior to that, the children's eyes are straight but as their world expands and their focusing mechanisms develop... |
| 40. | they may suddenly or intermittently develop an esotropia as they focus and accommodate. |
| 41. | In the early stages the eyes may be straight intermittently and... |
| 42. | inwardly deviated intermittently. Accommodative esotropia develops because of an abnormal relationship between the converging
muscles (medial recti) and the accommodating or focusing muscles (the ciliary body inside the eye). Normally there is a linear relationship between the two, but in children with accommodative esotropia this relationship is disturbed and there is an over convergence response to accommodating or focusing effort.
These children tend to be quite hyperopic (far sighted) and treatment is directed at correcting the far sightedness with glasses. When the need to focus is corrected by the glasses, the children no longer overconverge. |
| 43. | shows a child with accommodative esotropia with crooked eyes,while... |
| 44. | demonstrates perfect alignment with her hyperopic correction. These glasses have little to do with vision and the children see equally well with and without their glasses. However the glasses do the focusing for the child and their eyes are instantaneously straightened with the glasses. |
| 45-46. | The problem is often familial and often one or other of the parents has had the problem. Some children with accommodative esotropia have more esodeviation at near than they have at distance. |
| 47. | shows a child focusing in the distance on a non accommodative target and her eyes are straight. In... |
| 48. | she has begun to focus on a small object and a right esotropia is readily apparent. |
| 49. | shows perfect alignment at distance with hyperopic corrective spectacles, but... |
| 50. | shows an esodeviation when she now looks at something at near. |
| 51. | Shows fixation at near through a bifocal of stronger power placed in the bottom of her glasses and re-establishment of alignment. |
| 52-53. | This type of accommodative esotropia is not as common and most
children with accommodative esotropia require simply a single
vision lens to restore binocularity. Many children with accommodative
esotropia do not come completely straight with spectacles alone and remain with a relatively small angle of esotropia which many not be readily apparent. However this is very amblyogenic and many of these children require occlusion therapy until the age of seven. |