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Esotropia - External and Internal Eye
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Esotropia - External and Internal Eye

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Contributors: Rachel Ellis MD, Andrew Goodfriend MD, Brandon D. Ayres MD, Christopher Rapuano MD, Harvey A. Brown MD, Sunir J. Garg MD, Lauren Patty Daskivich MD, MSHS
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Synopsis

Esotropia is when the eyes cross inward. This type of ocular deviation accounts for more than 50% of pediatric strabismus. The esotropia can be congenital or due to excessive accommodation, divergence insufficiency, or sensory deprivation; it can be consecutive following strabismus surgery or due to neurologic disorders. 

Congenital esotropia presents in infants by 6 months of age and is usually found in otherwise healthy children. There is often a family history of strabismus. Up to 30% of children with cerebral palsy, hydrocephalus, and other neurologic disorders also have congenital esotropia. It is associated with a large degree of deviation and sometimes inferior oblique overaction, nystagmus, and dissociated vertical deviation. 

Accommodative esotropia is another common cause of esotropia in children. Its onset is usually around 2 years of age, often intermittent at first; it may be associated with uncorrected hyperopia and is frequently associated with amblyopia. In the nonrefractive accommodative type of esotropia, the deviation is significantly worse at near than at distance because of excessive convergence tonus from accommodation.

While adults with acute onset of esotropia often complain of diplopia, children compensate by either ignoring the vision in one eye (leading to amblyopia) or alternating the eye that is being used. 

Esotropia may be seen in association with the following: Duane syndrome (type 1), sixth nerve palsy, sensory deprivation (secondary to cataract, retinal scars, orbital pseudotumor), thyroid disease with medial rectus restriction, and pterygia with restriction of lateral gaze.

Codes

ICD10CM:
H50.00 – Unspecified esotropia

SNOMEDCT:
16596007 – Esotropia

Look For

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

Pseudoesotropia (wide, flat nasal bridge)

Esophoria (a latent esodeviation that is controlled with binocular fusion and brought out with alternate cover testing)

Esotropia may be seen in association with:
  • Duane syndrome (type 1)
  • Sixth nerve palsy
  • Sensory deprivation (secondary to cataract, retinal scars, orbital pseudotumor)
  • Thyroid disease with medial rectus restriction
  • Pterygia with restriction of lateral gaze

Best Tests

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Management Pearls

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Therapy

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Drug Reaction Data

Below is a list of drugs with literature evidence indicating an adverse association with this diagnosis. The list is continually updated through ongoing research and new medication approvals. Click on Citations to sort by number of citations or click on Medication to sort the medications alphabetically.

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References

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Last Updated: 01/29/2013
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Esotropia - External and Internal Eye
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Esotropia : Blurred vision, Diplopia, Nystagmus, Strabismus
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