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Acquired Esotropia

  • Author: Mauro Fioretto, MD; Chief Editor: Hampton Roy, Sr, MD  more...
Updated: Sep 30, 2014


Esotropia is a type of strabismus or eye misalignment. The term is derived from 2 Greek words: ésò, meaning inward, and trépò, meaning turn. In esotropia, the eyes are crossed; that is, while one eye looks straight ahead, the other eye is turned in toward the nose. This inward deviation of the eyes can begin as early as infancy, later in childhood, or even into adulthood.

Acquired esotropia can occur after infancy and is not always responsive to farsighted glasses; because of this, it does not fall into the categories of congenital esotropia or accommodative esotropia, which are described in other articles. However, an accommodative component may be associated.

Although acquired esotropia can occur in patients aged 1-8 years, it typically develops in patients aged 2-5 years and appears to be infrequently associated with an underlying disease. With acquired esotropia, the angle of deviation is relatively small, and early surgical correction (when indicated) is more likely to achieve bifoveal fixation for these patients than for those with congenital esotropia.



Additional laboratory and clinical research often is required to determine the etiology of the acquired strabismus. Scientists agree that some strabismus cases arise from a primary motor anomaly, while others arise from a primary sensory anomaly. Although different treatment approaches clearly are needed for different conditions, no agreement exists on the details for many conditions.





Of those children with esotropia, 10.4% of them are diagnosed with acquired esotropia.


Organic pathologies have been diagnosed in patients initially presenting with strabismus. In a recent study, 11.52% of patients with strabismus had posterior segment abnormalities. The most common diagnoses included Toxoplasma chorioretinitis, morning glory anomaly, Toxocara retinopathy, retinopathy of prematurity, and Coats disease. The mean age of onset of the deviation was found to be significantly lower in patients with esotropia. No correlation existed between the degree of visual impairment and the direction of deviation. This fact emphasizes the importance of performing a fundus examination in each patient presenting with strabismus.


No racial predilection exists.


No sexual predilection exists.


The median age of onset for children with acquired esotropia is 31.4 months (range, 8-63 mo), with a mean initial angle of deviation of 24 prism diopters (PD).

Contributor Information and Disclosures

Mauro Fioretto, MD Professor of Ophthalmology, University Eye Clinic of Genova; Head of Ophthalmology Department, Hospital of Casale Monferrato, Italy

Disclosure: Nothing to disclose.


Antonio Pascotto, MD Consulting Ophthalmologist, Pascotto, Istituto per la Salute degli Occhi, Clinica Mediterranea, Italy

Disclosure: Nothing to disclose.

Sergio Claudio Saccà, PhD Professor of Ophthalmology, Department of Neurological and Visual Sciences, Ospedale San Martino, Italy

Disclosure: Nothing to disclose.

Vincenzo Orfeo, MD Head, Operating Unit, Clinica Mediterranea, Naples, Italy

Vincenzo Orfeo, MD is a member of the following medical societies: American Academy of Ophthalmology

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

J James Rowsey, MD Former Director of Corneal Services, St Luke's Cataract and Laser Institute

J James Rowsey, MD is a member of the following medical societies: American Academy of Ophthalmology, American Association for the Advancement of Science, American Medical Association, Association for Research in Vision and Ophthalmology, Florida Medical Association, Sigma Xi, Southern Medical Association, Pan-American Association of Ophthalmology

Disclosure: Nothing to disclose.

Chief Editor

Hampton Roy, Sr, MD Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences

Hampton Roy, Sr, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, Pan-American Association of Ophthalmology

Disclosure: Nothing to disclose.

Additional Contributors

Michael J Bartiss, OD, MD Medical Director, Ophthalmology, Family Eye Care of the Carolinas and Surgery Center of Pinehurst

Michael J Bartiss, OD, MD is a member of the following medical societies: American Academy of Ophthalmology, North Carolina Medical Society, American Academy of Pediatrics, American Association for Pediatric Ophthalmology and Strabismus

Disclosure: Nothing to disclose.

  1. Kemmanu V, Hegde K, Seetharam R, Shetty BK. Varied aetiology of acute acquired comitant esotropia: A case series. Oman J Ophthalmol. 2012 May. 5(2):103-5. [Medline]. [Full Text].

  2. Firth AY. Heroin and diplopia. Addiction. 2005 Jan. 100(1):46-50. [Medline].

  3. Ludwig IH, Smith JF. Presumed sinus-related strabismus. Trans Am Ophthalmol Soc. 2004. 102:159-65; discussion 165-7. [Medline].

  4. [Guideline] American Academy of Ophthalmology Pediatric Ophthalmology/Strabismus Panel. Esotropia and exotropia. San Francisco (CA): American Academy of Ophthalmology. 2007. [Full Text].

  5. Repka MX, Wentworth D. Predictors of prism response during prism adaptation. Prism Adaptation Study Research Group. J Pediatr Ophthalmol Strabismus. 1991 Jul-Aug. 28(4):202-5. [Medline].

  6. Ho TH, Lin MC, Sheu SJ. Surgical treatment of acquired esotropia in patients with high myopia. J Chin Med Assoc. 2012 Aug. 75(8):416-9. [Medline].

  7. Clark AC, Nelson LB, Simon JW. Acute acquired comitant esotropia. Br J Ophthalmol. 1989 Aug. 73(8):636-8. [Medline].

  8. Kittleman WT, Mazow ML. Reoperations in esotropia surgery. Ann Ophthalmol. 1986 May. 18(5):174-7. [Medline].

  9. Schoffler C, Sturm V. Repeated surgery for acute acquired esotropia: is it worth the effort?. Eur J Ophthalmol. 2009 Dec 16. [Medline].

  10. Clark RA, Ariyasu R, Demer JL. Medial rectus pulley posterior fixation: a novel technique to augment recession. J AAPOS. 2004 Oct. 8(5):451-6. [Medline].

  11. Jang GJ, Park MR, Park SC. Bilateral lateral rectus resection in patients with residual esotropia. Korean J Ophthalmol. 2004 Dec. 18(2):161-7. [Medline].

  12. Costello PA, Simon JW, Jia Y, Lininger LL. Acquired esotropia: subjective and objective outcomes. J AAPOS. 2001 Jun. 5(3):193-7. [Medline].

  13. Fukai S, Arai N, Hayakawa T, Kimura H. Studies on the botulinum therapy for esotropia improvement of retinal correspondence. Nippon Ganka Gakkai Zasshi. 1993 Jun. 97(6):757-62. [Medline].

  14. Goldman HD, Nelson LB. Acute acquired comitant esotropia. Ann Ophthalmol. 1985 Dec. 17(12):777-8. [Medline].

  15. Lyons CJ, Tiffin PA, Oystreck D. Acute acquired comitant esotropia: a prospective study. Eye. 1999 Oct. 13 (Pt 5):617-20. [Medline].

  16. Mohney BG. Acquired nonaccommodative esotropia in childhood. J AAPOS. 2001 Apr. 5(2):85-9. [Medline].

  17. Mohney BG. Common forms of childhood esotropia. Ophthalmology. 2001 Apr. 108(4):805-9. [Medline].

  18. Thomas AH. Divergence insufficiency. J AAPOS. 2000 Dec. 4(6):359-61. [Medline].

  19. Troost BT, Abel L, Noreika J, Genovese FM. Acquired cyclic esotropia in an adult. Am J Ophthalmol. 1981 Jan. 91(1):8-13. [Medline].

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