Esotropia: Causes, Symptoms, and Treatment
Medically reviewed by Harsha Moole, MD, Internal Medicine. Last reviewed: October 23, 2026.
What kind of doctor treats Esotropia?
An ophthalmologist, a medical doctor who treats eye problems, usually treats esotropia. In esotropia, one eye turns inward toward the nose. Children may see a pediatric ophthalmologist, an eye doctor for children. A direct primary care or concierge doctor can be a first stop for an evaluation and can refer you to a specialist when needed.
What is esotropia?
Esotropia is an eye misalignment in which one eye turns inward toward the nose. The turn may be constant or come and go. It may switch between the eyes, or only one eye may turn.
Esotropia is a form of strabismus, a disorder in which the eyes do not line up in the same direction. The most common form of strabismus is known as crossed eyes.
Infantile esotropia is present in the first 6 months of life. Its cause is unknown. Accommodative esotropia is the most common type. It is an inward turning of one or both eyes when the eyes focus. Brief eye misalignment is common in babies up to 3 months of age and is not the same as infantile esotropia.
Symptoms
Symptoms may be present all the time or may come and go. They can include:
- Crossed eyes.
- Double vision.
- Eyes that do not aim in the same direction.
- Eyes that do not move together.
- Loss of vision or depth perception.
Children may never be aware of double vision, because amblyopia can develop quickly. Amblyopia is also called lazy eye. Children usually learn to ignore the image from the turned eye, and this can lead to amblyopia. About half of children with esotropia will develop amblyopia.
Causes and who gets it
In most children with strabismus, the cause is unknown. Most of the time, the problem has to do with muscle control, not muscle strength.
These raise the risk of esotropia:
- Farsightedness.
- Prematurity and low birth weight.
- Smoking by the mother during pregnancy.
- Hydrocephalus and other brain development problems.
- Chromosome problems or differences in the bones of the face.
- A family history of strabismus.
In adults, strabismus can be caused by diabetes. Graves disease, injury to the eye, and stroke can also cause it. So can vision loss from any eye disease or injury.
How doctors diagnose it
All people with esotropia need a complete eye exam. The doctor checks how well you see and how the eyes line up and move.
Tests may include:
- A corneal light reflex test.
- A cover/uncover test.
- A retinal exam.
- A visual acuity test.
- A brain and nervous system exam.
Sudden esotropia can point to a nervous system problem, especially with headache, nausea or vomiting. A brain scan may be considered in some children.
Treatment
The first step in treating strabismus in children is glasses, if needed. Next, amblyopia must be treated, with a patch over the better eye. This forces the brain to use the weaker eye.
Other nonsurgical options include fully correcting farsightedness. Prism glasses can relieve double vision in some people. Eye exercises may help in some adults. Adults with mild strabismus that comes and goes may do well with glasses.
Botulinum toxin injections into the eye muscles have been shown to work in some types of esotropia. Results may not last as long as with surgery.
Eye muscle surgery may be needed if the eyes still do not move correctly. Surgery does not fix the poor vision of a lazy eye. A child may still have to wear glasses after surgery. Surgery is more often successful if done when the child is younger.
In most cases, the problem can be corrected if it is found and treated early. Permanent vision loss in one eye may occur if treatment is delayed. Many children get strabismus or amblyopia again after treatment, so they need close follow-up.
When to see a doctor
Any appearance of crossed eyes in a young child should be checked right away. So should crossed eyes that start recently in an adult. Contact your provider or eye doctor if your child complains of double vision. Also call if your child has difficulty seeing.
Sudden crossed eyes can point to a nerve or brain problem. Call 911 or go to the emergency room if sudden crossed eyes or double vision comes with a severe headache, vomiting, sudden weakness, trouble speaking, confusion, or fainting.
How a direct primary care or concierge doctor fits in
A direct primary care doctor charges a flat monthly fee instead of billing insurance, while a concierge doctor usually charges more and often works alongside insurance. Such a doctor can note when the eye turn began, check for related health problems, and refer you or your child to an ophthalmologist.
Common questions
What is the difference between esotropia and strabismus?
Strabismus means the eyes do not line up in the same direction. Esotropia is the type in which an eye turns inward toward the nose. The most common form of strabismus is known as crossed eyes.
Can esotropia cause a lazy eye?
Yes, esotropia can lead to amblyopia, also called lazy eye. If strabismus is not treated, the eye that the brain ignores will never see well.
Can esotropia be treated?
Yes, in most cases the problem can be corrected if it is found and treated early. Treatment can include glasses, a patch over the better eye, and eye muscle surgery.
Can adults get esotropia?
Yes, esotropia can start in adults, and it can cause double vision. Diabetes is one cause of strabismus that starts in adults.
Sources
- American Academy of Ophthalmology - EyeWiki: Esotropia
- MedlinePlus - Strabismus
- MedlinePlus - Crossed eyes
Medical Disclaimer
This content is for general educational and informational purposes only and is not medical advice. It is not a substitute for professional medical advice, diagnosis, or treatment, and reading it does not create a doctor-patient relationship. Always seek the advice of your physician or another qualified health provider with any questions about a medical condition, and never disregard or delay seeking professional advice because of something you read here. If you think you may have a medical emergency, call 911 (or your local emergency number) immediately.
