Esotropia (Crossed Eyes): Causes, Types, Symptoms, and Treatment
Updated: 6 days ago
Medically reviewed by Dr. Baraa Alnahhal, MD · Last reviewed: October 2026
Source currency note: This guide reflects medical information reviewed in October 2024. Always confirm current guidance with your eye care professional.
Quick Answer
Esotropia is a type of strabismus, or eye misalignment, in which one or both eyes turn inward toward the nose. It can happen at any age but most commonly appears in babies and children, and it can affect vision and depth perception. Treatment includes glasses, amblyopia treatment, prisms, injections or surgery, and the outlook is good. [4]
What the research says
Glasses work best for most children. A systematic review of 34 studies covering 3,877 children (average age about 4.7 years) found that optical correction had the highest effectiveness rate at 79.3%, compared with 71.4% for eye muscle surgery and 61.2% for botulinum toxin injections, with success defined as a remaining eye turn of less than 10 prism diopters (Alrasheed et al., PeerJ, 2025 [1]).
Esotropia affects roughly 60 million people worldwide. Pooling 315 population-based and 374 clinic-based studies, researchers estimated that horizontal strabismus affects 1.81% of people (138.5 million), including 0.67% with esotropia (60.0 million) and 1.14% with exotropia (87.5 million) (von Bartheld et al., Survey of Ophthalmology, 2026 [2]).
Treating strabismus is not just cosmetic. A systematic review of how strabismus affects children and adults found that negative attitudes toward people with misaligned eyes can harm self-image, and that treatment has the potential to improve psychosocial health and quality of life, with or without double vision (Buffenn, Survey of Ophthalmology, 2021 [3]).
What is esotropia?
Esotropia is an eye condition in which one or both of your eyes turn inward. It is a type of strabismus, which means your eyes do not line up or align correctly. Some people refer to esotropia as being “cross-eyed” [4].
Key point | What it means |
One or both eyes | Esotropia can be monocular (involves one eye) or binocular (involves both eyes) |
Muscle coordination | The muscles and nerves that control your eyes usually let both eyes work together; in esotropia, this control is not as coordinated as it should be |
The opposite condition | Esotropia is the opposite of exotropia, the turning outward of the eyes |
When it appears | Esotropia can happen at any age, but it commonly occurs in babies and children |
Beyond vision | It can affect a child’s vision and also their social and emotional development; many children experience reduced self-esteem because of how the condition looks |
That last point is why it is important to seek diagnosis and treatment as soon as you notice symptoms [4].
Types of esotropia
There are many different kinds of esotropia [4]:
Type | What it means | Treatment implication |
Intermittent esotropia | Comes and goes; is not present all the time | May not always need treatment |
Constant esotropia | Present all the time | Usually requires treatment |
Infantile or congenital esotropia | Present at birth or develops in early infancy | Often needs early intervention |
Alternating esotropia | Occurs in both eyes but at different times | Either eye can be affected at any time |
Accommodative esotropia | Caused by the eyes’ focusing effort | Treatable with glasses or contact lenses |
Nonaccommodative esotropia | Not related to focusing effort | Cannot be treated with corrective lenses; you may need surgery |
Pseudoesotropia | Appears to be esotropia because of a flat bridge of a baby’s nose and extra skin covering the inner corners of the eyes (epicanthal folds) | Does not need treatment; children grow out of it with age |
Symptoms of esotropia
The main symptom of esotropia is that one or both of your eyes turn inward toward your nose. You may not be able to see it yourself if you have it [4].
Symptom | What you might notice |
Inward eye turn | One or both eyes turn inward toward the nose; this is the main sign |
Eyes do not move together | The eyes are not coordinated when looking at objects |
Squinting, blinking, and head turning | Ways of compensating to see better, which can lead to eye strain |
Depth perception problems | Difficulty judging how close things are |
Diplopia (double vision) | Seeing two images instead of one |
Amblyopia (lazy eye) | Decreased vision in one eye |
What causes esotropia?
Esotropia is caused by a lack of coordination of your eye muscles. Normally, your eye muscles work together as a binocular system (“seeing with two eyes”). Working together lets you tell how close you are to something, which matters when you are riding a bicycle, driving a car, or reading [4].
Underlying factor | How it relates to esotropia |
Farsightedness | Young children with esotropia are typically farsighted, meaning they see things far away more clearly than things up close. Sometimes esotropia is a sign that you need glasses to correct farsightedness |
Genetics | Esotropia is sometimes genetic; you may have biological family members with misaligned eyes |
A problem inside one or both eyes | Such as a cataract, retina problem, or optic nerve problem |
An issue affecting the brain | Such as increased intracranial pressure or a brain tumor |
Neurological conditions | Such as stroke or nerve damage from diabetes |
Eye injury | Trauma to the eye or its surroundings |
Thyroid conditions | Thyroid disease can affect eye muscle function |
Risk factors
Esotropia has many potential risk factors [4]:
Risk factor | Detail |
Preterm birth | Babies born prematurely are at higher risk |
Biological family history of strabismus | Misaligned eyes can run in families |
Substance and alcohol use during pregnancy | Increases risk for the child |
Genetic variations | Can contribute to eye misalignment |
Neurologic disorders | Affect nerve and muscle control of the eyes |
High farsightedness | Strong uncorrected farsightedness raises risk |
Other health conditions | Including hyperthyroidism and diabetes |
Complications of esotropia
Esotropia makes it hard for your eyes to work together, which can lead to several vision complications [4]:
Complication | What happens |
Double vision | The eyes cannot fuse two images into one |
Problems with peripheral vision | Side vision is affected |
Loss of 3-D and binocular vision | The eyes stop working as a team |
Blurry vision | Vision becomes unfocused |
Amblyopia | Decreased vision in one eye (lazy eye) |
Beyond vision, people are likely to experience a loss of self-confidence because of cosmetic concerns, which can lead to social anxiety and performance issues in school and other activities [4].
How is esotropia diagnosed?
Your healthcare provider may refer you to an ophthalmologist or optometrist. The provider will ask about your family and medical history and perform an eye examination [4].
Test | What it measures |
Visual acuity test | How clearly you can see at various distances |
Refraction test | Tests your eyes with corrective lenses to measure how they focus light |
Alignment and focus tests | Whether and how much the eyes are misaligned |
Pupil dilation (widening) test | Determines the health of your internal eye structures |
Treatment for esotropia
Some cases of esotropia may get better on their own. For those that do not, your eye care specialist may suggest one of these treatments or a combination of them [4]:
Treatment | How it works |
Glasses or contact lenses | Correct refractive errors; the standard treatment for accommodative esotropia |
Amblyopia treatment | Patching the stronger eye or using a dilating eye drop to blur the vision of the stronger eye, which forces the weaker eye to work |
Prisms | Special lenses that help the eyes align images |
Botulinum toxin (Botox) injections | Injections that temporarily weaken overactive eye muscles |
Strabismus surgery | Surgery to adjust the eye muscles for lasting alignment |
If esotropia is a symptom of another condition, your healthcare provider will treat that condition. Esotropia usually improves when you manage whatever is causing it [4].
Outlook and prevention
What is the outlook?
If you have treatment for esotropia, such as glasses, contact lenses, or surgery, your prognosis (outlook) is good. It is important to follow your treatment plan carefully and see your provider for regular follow-up appointments [4].
Can esotropia be prevented?
You cannot prevent esotropia entirely, but you can help your child manage it by taking them for regular eye exams as soon as you notice any changes in their eyes or vision [4].
When to call the provider
If your child’s eyes are bothering them at any point, such as squinting a lot or moving objects around to focus better, call their healthcare provider. This is also true for you. If your eyes, or your child’s eyes, change suddenly and look different, call your provider, especially if the changes happen after an injury. After an injury, get help right away [4].
Questions to ask your provider
If you or your child is diagnosed, these questions can help [4]:
Question | Why it matters |
What type of esotropia do I or my child have? | The type determines the treatment path |
What treatment options do you recommend? | Options range from glasses to surgery |
Will treatment affect school, sports, and daily activities? | Helps you plan around the treatment plan |
Conclusion: when to talk to your doctor
Esotropia is a common eye condition that can affect your vision, which makes work, sports, and daily activities difficult. It can also affect your self-image and make social interactions harder than they need to be. If you or your child has esotropia, it is important to get a timely diagnosis. The sooner you begin treatment, the sooner it can correct your eye alignment [4].
If you notice one or both eyes turning inward, squinting, head tilting, or any sudden change in eye appearance, see an eye care professional promptly. Early treatment protects vision and self-confidence. Explore our related guide on farsightedness (hyperopia) for a fuller picture of vision health.
Frequently Asked Questions
What is esotropia?
Esotropia is an eye condition in which one or both eyes turn inward toward the nose. It is a type of strabismus (eye misalignment), and some people call it being “cross-eyed.” It can be monocular (one eye) or binocular (both eyes).
What are the symptoms of esotropia?
The main symptom is one or both eyes turning inward. Other symptoms include eyes that do not move together, squinting, blinking and head turning to see better, problems with depth perception, double vision (diplopia), and amblyopia (decreased vision in one eye).
What causes esotropia?
Esotropia is caused by uncoordinated eye muscles. Common contributing factors are farsightedness (especially in children), genetics, and sometimes underlying problems inside the eye (cataract, retina or optic nerve issues), in the brain (increased intracranial pressure, brain tumor), or from neurological conditions (stroke, diabetic nerve damage), eye injury, and thyroid disease.
What is the difference between esotropia and pseudoesotropia?
Pseudoesotropia only appears to be esotropia. It is caused by a flat bridge of a baby’s nose and extra skin covering the inner corners of the eyes (epicanthal folds). It does not need treatment, and children grow out of it with age.
What are the types of esotropia?
There are seven forms: intermittent (comes and goes), constant (always present), infantile or congenital (present at birth or in early infancy), alternating (both eyes at different times), accommodative (treatable with glasses or contacts), nonaccommodative (may need surgery), and pseudoesotropia (a harmless appearance children grow out of).
Is esotropia genetic?
Esotropia is sometimes genetic, and you may have biological family members with misaligned eyes. Family history of strabismus is a known risk factor, along with preterm birth, substance or alcohol use during pregnancy, genetic variations, neurologic disorders, high farsightedness, hyperthyroidism, and diabetes.
What are the complications of esotropia?
Complications include double vision, peripheral vision problems, loss of 3-D and binocular vision, blurry vision, and amblyopia. Cosmetic concerns can also cause loss of self-confidence, social anxiety, and performance issues in school.
How is esotropia diagnosed?
An ophthalmologist or optometrist takes a family and medical history and performs an eye examination, including a visual acuity test, refraction test, alignment and focus tests, and a pupil dilation test to check the internal eye structures.
How is esotropia treated?
Some cases improve on their own. Otherwise, treatment may include glasses or contact lenses, amblyopia treatment (patching or dilating drops on the stronger eye), prisms, botulinum toxin (Botox) injections, and strabismus surgery, alone or in combination. If esotropia results from another condition, treating that cause usually improves the alignment.
What is the outlook for esotropia?
With treatment, the outlook is good. It is important to follow the treatment plan carefully and attend regular follow-up appointments.
Can esotropia be prevented?
You cannot prevent esotropia entirely, but regular eye exams for your child as soon as you notice changes in their eyes or vision help catch and manage it early. Sudden eye changes, especially after an injury, need immediate care.
References
Alrasheed SH, Challa NK, Aljohani S, et al. Effectiveness of treatment modalities for childhood esotropia: a systematic review. PeerJ. 2025;13:e19584. PMID 40538735. https://doi.org/10.7717/peerj.19584
von Bartheld CS, Hagen MM, Jiang J, et al. The global prevalence of horizontal strabismus: a systematic review and meta-analysis with a focus on ethnic variation. Survey of Ophthalmology. 2026;71(6):1803-1839. PMID 42106004. https://doi.org/10.1016/j.survophthal.2026.05.002
Buffenn AN. The impact of strabismus on psychosocial health and quality of life: a systematic review. Survey of Ophthalmology. 2021;66(6):1051-1064. PMID 33773997. https://doi.org/10.1016/j.survophthal.2021.03.005
Cleveland Clinic. Esotropia. Cleveland Clinic. October 30, 2024. https://my.clevelandclinic.org/health/diseases/23145-esotropia
Medical disclaimer
This article was prepared for general information only and is not a substitute for professional medical advice.
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