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accommodative esotropia

I have been suspicious since Talia was about 8 weeks old that something was up with her eyes. For one she has had clogged tear ducts since birth but the thing that stuck out to me was how often she was cross-eyed in the awake photos I took of her. I probably pay attention to this because I am a photographer and I am always scrutinizing the catch light’s in eyes.  It is normal for newborns to be cross-eyed and I see it all the time. Most newborns that I photograph are cross-eyed for at least some of their newborn photos but the eye crossing is supposed to stop at around 8 weeks.  Continuous eye crossing after 8 weeks can be a sign of vision and brain problems, I know this because I looked it up on WebMD, which I don’t recommend doing as every symptom on WebMD points directly to cancer . It scared me bad enough that I made an appointment with a pediatric optometrist and had Talia’s eyes examined at 3 months of age.  3 months is young for a first eye exam but the receptionist told me it couldn’t hurt to look especially since I had concerns.

All my friends and family wanted to know how an optometrist measures a non verbal child’s eyesight – and the answer is retinoscopy, it’s a technique that uses a tool called a retinoscope to examine the reflection of light on the back of the retina.  It’s pretty complicated but this youtube video explains it very nicely. http://www.youtube.com/watch?v=kAreDffuVCQ In short the optometrist dilated Talia’s eyes and then wore a set of really funny looking goggles (the retinoscope) that shown a light into T’s eyes. In the video they show a hand held retinoscope but T’s optometrist had a hands free one that strapped to her head (probably because she works with kids all day and you need both hands free for that).

The optometrist eased my fears that T had some sort of brain tumor but she did note that Talia was farsighted. Actually all babies are farsighted but Talia was “out of the range of normal”. The optometrist wanted to wait two months and then exam T’s eyes again. An Infant’s vision is constantly improving so in just 2 months time she might have been back in the “range of normal”. So we waited 2 months and in the mean time I was instructed to take photos of Talia crossing her eyes /miss alignment. so I did.

I think Myles was even skeptical because when she does this eye misalignment thing it’s not like her eyes are “stuck” looking at her nose. She moves in and out of it as she looks around at different things but whenever she looks at something up close she turns one eye in, sometimes it’s subtle, sometimes it’s dramatic.  So two weeks ago I took her back to the optometrist and repeated the exam – no change. Meaning Talia’s vision did not improve at all in the two-month time frame. Not really good news when you’re an infant and your vision is supposed to be constantly improving.

Talia was diagnosed with accommodative esotropia.  You can google that but it is the most common form of strabismus (miss-alignment of the eyes) and it means that she crosses her eyes inward because she is over compensating  by tightening the muscle in her eye for not being able to bring a close object into focus. Talia seems to be alternating the eye that she crosses (see above photos) so she is not suffering from amblopia, which is decreased vision in just one eye (which is often treated with an eye patch) The problem with having misaligned eyesight is that the human brain hates double vision. So instead of trying to make sense of the double image the brain just turns off one eye. Eventually if not corrected the child will completely loose their binocular vision.

So to help with this problem T gets little baby glasses to correct her farsightedness.  Yes, they are cute for the fist day or so after that you realize what a nightmare it is to keep glasses on a baby and to keep them clean. We have also gotten the strangest questions about them “are they real?”, “does she really need those?” (trust me it’s a lot of work to keep the glasses on the baby – no one is using them as a fun accessory!). But we have also heard a lot of encouraging words from adults that suffered from this condition but now have great vision. It is possible that Talia will outgrow farsightedness in late childhood/ early teen years but she may need glasses for the rest of her life. I don’t really see this as a big deal as According to the Vision Council of America; approximately 75% of adults use some sort of vision correction (glasses or contacts).  Also people with accommodative esotropia are great candidates for LASIK.

I am just beginning to research and understand this condition but it is quite common. According to the College of Optometrist  – esotropia is the most common type of strabismus, occurring in approximately 1-2% of the population. Talia is just on the young side for being diagnosed. This experience has made me an advocate for having all babies eye’s examined.  Getting treatment for vision problems young can make all the difference and you can get a FREE eye exam through a program called  Infant see (http://infantsee.org/) and they recommend having an eye exam between ages 6 and 12 months,  which I now recommend  for all children. I think if we waited until Talia was 2 or 3 to work on correcting her vision she might have totally lost her binocular vision which can make tracking a line of text and reading very difficult this cold also limit her future career choices.  Right now we are just seeing the optometrist but it has been suggested to me that Talia see a pediatric ophthalmologist and start vision therapy. I am going to consult with her pediatrician at her 6 month well child check coming up in a few weeks and she what she recommends. Talia still has one clogged tear duct (her right eye) but the left eye cleared about a month ago. If her right eye doesn’t clear by 12 months of age she will likely have to have surgery on it. Clogged tear ducts are a result of the membrane in the duct not opening. It’s very common but there is really not much you can do for it since it’s a physical barrier to the tears draining from the eye out through the nose.

If you have a child with accommodative esotropia or another vision difficulty or if you yourself have been diagnosed with accommodative esotropia I would love to hear about your experience – please leave me a comment.

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  1. Leah y

    We adopted a relative who had a traumatic brain injury. When we took pictures, we noticed that her eyes would do the same thing. In fact, the eye doctor thought I was crazy till I showed him pictures because every time we went in her eyes would act ‘normal’. I will always Check photos from now on with my children to see if the reflections are equal. It’s amazing what a photo reveals! and yes she has glasses. She got them when she was ~3.

  2. I am sure that those things are a pain to keep on her! Babies take off their socks, I can’t imagine what they would do with glasses! But she is so stinkin cute in them!!!!

  3. Faye Morris

    Great write up Emily, very informative.

  4. Emily that blog was very informative! I had a friend whose baby was born with a cateract in his eye. They had surgery on the eye and then had to patch it. After a year the “bad:” eye was seeing better than the “good” eye so now he has glasses two! I think they are adorable!

  5. My son was diagnosed with Accommodative Esotropia toward the end of last year. He was 4. He never showed any signs when he was younger, but about 6 months ago I began to notice that his eyes would cross for a brief moment at night when he was tired and then occasionally during the day so I took him to see a Pediatric Ophthalmologist. Good thing I did! Poor little guy was practically blind (both eyes are +600)! So far he’s made tremendous progress and he has a check up in a couple of weeks to determine whether or not we’ll have to patch one of his eyes for a few hours a day.

    Oh, and your daughter is adorable! Here’s my little man:

  6. Ashley

    I am so glad you posted this! I have an appoinment to take my 9 month old daughter to the eye doctor for this same thing (or so we think) on Tuesday. I’m glad I got to see your pictures of her in glasses so I know what to expect and also to hear about the eye exam. I also googled and looked everything up on WebMD and worried myself sick before making the appt. I would love to hear more about Talia’s progress. If you want to see pictures of my daughter’s eyes you can friend me on facebook and we can chat more! http://www.facebook.com/?ref=logo#!/profile.php?id=779042948

    P.S. I am really not looking forward to all the comments when we have to get glasses for Camryn. 🙁

  7. Laura

    So funny! I found your blog through the woman who does the Savory Sweet Life blog. We’re dealing with the same thing with our son. About 2 months ago, out of no where he started crossing his one eye inward. We pick up his glasses tomorrow after seeing the pediatric ophthalmologist two weeks ago. He’s getting the miraflex baby glasses (like goggles w/ a strap and flexible). He’s 20 months old… so I’m assuming it’s going to be lots of fun trying to get him to keep them on! Good luck to you & Talia!

  8. Sylvie

    your post is such a coincidence…I just took my 3 year old to the optometrist this very afternoon because I was concerned his left eye seems to go inwards when he was focusing and it was getting more pronounced. I was also getting it a lot in his pictures, when he was looking at the camera. It did not start as young as Talia, just got bad enough now that it was starting to be notable but this mama (my husband agreed after I pointed it out, especially on the pictures but had not really noticed it in every day life). I am very glad I took him in before he started to loose more of his binocular vision. We should have his glasses in a couple of days and for the moment, he does not seem to upset to have to wear some. The optometrist seems pretty confident that the glasses should resolved the problem if his is good at wearing them. His farsightedness might goes away as he grows but we’ll see. I will keep checking on Talia and compare notes.

  9. MElissa

    I had to wear glasses at 13 months of age till the age of junior high school for this exact same thing. I believe it was my right eye that had the strabismus. I have not had to wear any glasses since then. My mom always tells me the story about me trying to clean my glasses on the sidewalk!

  10. We have a friend with a daughter with the very same diagnosis and her little one has been wearing glasses since she was 5 months… When their optometrist came and spoke at our MOPS meeting last year, I was wondering how much she could really do to fill up about 45 minutes, but man, it was so interesting! She started off with a blanket apology for all vision care professionals because they just haven’t pushed to get all kiddos tested early or even on regular basis like the dental field has… Probably why many insurance companies don’t cover “well” check ups… My friend’s little girl has improved a lot and has progressed past needing surgery (
    her eyes crossed much more profoundly than the photos you posted of Talia), so the work behind keeping the glasses on (and it is hard work to keep ’em clean too- I’ve seen that!) is so worth it!

    • admin

      Now that I no more about it I think it’s even more important than dental care – at least with teeth you get a second chance, not so with eyes. I think pediatricians should encourage their patients to see an optometrists between the recommended 6-12 months.

  11. TNmom

    I am so glad I found your blog! How is your daughter doing. At my son’s 6 month check up my pedi noticed his eyes crossing (I thought it was normal) and she referred us to a pediatric opthalmologist to get his eyes checked and sure enough he believe my son has accomodative esotropia! We go back in tomorrow morning for a more in depth look. I am so nervous! Hope all is well with you!

    • admin

      I don’t think there is much to be nervous about – really it’s just glasses! please keep me up to date about your son – are you in the Seattle area?

  12. Annie

    Our 3-year-old JUST went through this. She too had really bad clogged ducts as an infant. They didn’t clear up entirely until about 4 months. Recently, her eyes just started crossing without any real explanation. She now has glasses. I can only imagine the annoyance of keeping glasses on a baby! It’s quite the chore with a 3-year-old, and at least we can ask her to keep them on. Like you, I was thankful to catch this early.

    • admin

      Hi Annie,
      I have just been doing some research on this did your daughters eye crossing correspond with getting the MMR vaccine? And I think it is probably easier to keep glasses on an infant than a 3 year old. Already T is very used to them and for the most part leaves them alone. The only time they bother her is when she is really tiered and wanted to rub her eyes.

  13. She looks beautiful in those glasses, too cute 🙂

  14. Larry J

    If you go to http://www.InfantSee.org you will find over 7,000 Optometrists that will provide a free infant vision evaluation. Every child deserves early, preventive vision care at ages 1,3, &5. Just reading the eye chart at the Pediatrician’s office is almost useless!

  15. Accommodative esotropia usually shows up between ages 2 and 4 years. If a child his highly hyperopic (farsighted) or has an over active focusing system (high Accommodative Convergence Accommodative Ratio ACA) an eye turn inward can result. Sometimes this eye turn is only partly accommodative in nature. More often than not a pair of glasses can work wonders. More often than not we think of glasses as cosmetic devices….we get blue ones to go with blue outfits and green ones to go with green outfits. They are medical devices that can be used as therapy. I often also give kids a bifocal to help this over active focusing system as well. Optometric vision therapy should also be considered. Let me know if you have any questions. dmaino@ico.edu Dr. Dominick Maino, Professor of Pediatrics/Binocular Vision Illinois Eye Institute/Illinois College of Optometry htto://www.ico.edu and Lyons Family Eye Care http://wwww.LyonsFamilyEyeCare.

    • admin

      I wonder if it quite frequently shows up more often in younger children it’s just not caught since young children most often do not have their eyesight tested? At any rate my daughter was showing definite sings of it at 3 months of age and now at 22 months she is wearing a +6 prescription in both eyes.