Esotropia in Infants: A Guide for Parents

Q: Esotropia in Infants: A Guide for Parents

Mr. <br>Li： Regarding your question, based on the description, there are some unclear areas that make it difficult to provide a precise answer. <br>I recommend visiting an outpatient clinic for an examination and consulting directly with a physician. <br>Generally, esotropia is a

An eight-month-old baby has esotropia?

Hello Dr.
Hsia, I apologize for bothering you, but I would like to ask about my daughter's condition.
We noticed that she seemed to have some esotropia around 3 to 6 months of age, but pediatricians who examined her said there was no issue.
It wasn't until she was 7 months old that we happened to visit an ophthalmologist, who diagnosed her with esotropia (approximately 15 degrees) and found that she is hyperopic with a prescription of about +3.00 diopters.
However, her condition is alternating.
Now at 8 months, one doctor suggested that we try glasses (with a prescription of +4.50 diopters), which she has been wearing for 2 weeks.
I have a few questions:
1.
If the glasses do not help, could they potentially harm her eyes?
2.
I feel there has been a slight improvement (as she seems to focus better on people), but strangely, she appears to have more of a cross-eyed look while wearing the glasses.
Is this normal?
3.
My daughter seems to focus well when looking at us up close, but when she looks about 4 to 5 meters away, her focus seems off.
Is this typical for esotropia, or is it common for such a young baby to have some difficulty?
4.
The doctor mentioned that if the glasses are ineffective, surgery may be necessary.
However, I have heard about botulinum toxin treatment; is this available in Taiwan, and is it less harmful for a young girl compared to surgery and anesthesia risks?
I sincerely apologize for taking up your valuable time, and I appreciate your kind assistance.
Thank you!

Li Baba, 30~39 year old female. Ask Date: 2010/06/14

Dr. Xia Weiwei reply Ophthalmology

Mr.
Li: Regarding your question, based on the description, there are some unclear areas that make it difficult to provide a precise answer.
I recommend visiting an outpatient clinic for an examination and consulting directly with a physician.
Generally, esotropia is a concern because it may affect visual development.
The physician suggested wearing glasses, which may indicate accommodative esotropia, but the prescribed prescription seems to have special considerations.
Typically, if the condition is not too severe, patching therapy is recommended initially.
As for the botulinum toxin treatment you mentioned, it is indeed available in Taiwan, but very few people undergo it due to its lack of precision and the need for injections every 2-3 months, which does not meet expectations and needs.
According to your description, the angle of esotropia is about 15 degrees, which is not considered severe.
I suggest further evaluation and discussion with your physician before making a decision.
Wishing you health and safety.
Summer Wei Wei.

Reply Date: 2010/06/14

More Info

Understanding esotropia in infants can be a source of concern for many parents, especially when it comes to the visual development of their child. Esotropia, commonly referred to as "crossed eyes," occurs when one or both eyes turn inward. This condition can manifest at various ages, and early detection and intervention are crucial for optimal outcomes.

1. Wearing Glasses and Potential Eye Damage: Your daughter has been prescribed glasses to correct her significant hyperopia (farsightedness) of +300 to +450 degrees. In infants, wearing glasses is generally safe and can help improve visual acuity and alignment. If the glasses are not effective, they are unlikely to cause harm; however, they may not address the underlying issue of esotropia. It is essential to monitor her response to the glasses closely. If you notice any discomfort or worsening of her condition, consult your pediatric ophthalmologist.

2. Perception of Crossed Eyes While Wearing Glasses: It is not uncommon for parents to perceive that their child looks more "cross-eyed" when wearing glasses, especially if the prescription is strong. This can occur due to the way the lenses interact with the eyes' alignment. The glasses are intended to help her focus better, which may improve her visual alignment over time. If you have concerns about her appearance or if the condition seems to worsen, it is vital to discuss this with her eye doctor.

3. Focus at Different Distances: Infants often exhibit varying degrees of visual acuity at different distances. It is normal for a baby to focus well on nearby objects while having difficulty with distant ones, especially if they have a significant refractive error like hyperopia. In cases of esotropia, the eyes may struggle to align properly at different distances, leading to inconsistent focus. Regular follow-ups with the eye specialist will help assess her progress and determine if further intervention is necessary.

4. Surgical Options and Botulinum Toxin Treatment: If the glasses do not yield the desired results, surgery may be considered to realign the eyes. Surgical intervention for esotropia is generally safe and effective, but like any surgery, it carries risks, including anesthesia complications. Botulinum toxin injections are another treatment option that can temporarily weaken the muscles causing the misalignment. This method is less invasive and may be appropriate for certain cases, but it is essential to consult with a pediatric ophthalmologist experienced in treating infants to determine the best course of action for your daughter.

In conclusion, managing esotropia in infants requires careful monitoring and collaboration with healthcare professionals. Regular eye examinations are crucial to assess the effectiveness of treatments and make necessary adjustments. If you have any concerns about your daughter's vision or treatment plan, do not hesitate to reach out to her eye doctor for guidance. Early intervention can significantly impact her visual development and overall quality of life.

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