Clear vision plays a pivotal role in a child’s overall physical and intellectual development and shapes the child´s ability to move around freely, learn to do intricate work and interact with the bigger world.
One common child vision concern is that of convergent eyes. This is often seen as convergent in-turning of one or both eyes, also known as convergent strabismus or esotropia, or simply a squint. We all can converge our eyes naturally when we accommodate and look at something close, but in convergent strabismus – esotropia – the child´s eyes appear over-converged and are not aligned properly. The child cannot use their eyes together to look in different directions. This can be noticeable when the child in looking in the distance or can be more exaggerated for near.
The poor alignment of the eyes interferes with the development of the child´s vision and can lead to a lazy eye or amblyopia. It is important to detect esotropia – convergent eyes – early on in life in order to treat amblyopia (poorly developed sight) and maximise the child´s visual potential for later in life.
Consultant Paediatric Ophthalmologists and Orthoptists regard convergent eyes in children, as more than just a cosmetic problem. It can be associated with visual impairment in one or both eyes, which may be detectable without specialist assessment. With convergent eyes the child´s vision may not be developing its full potential in one, or both eyes or there may be a more sinister pathology affecting the convergent eye. Full eye examination and motility testing is required to make the diagnosis and plan the treatment. Some children with convergent esotropia may simply require glasses, others need special orthoptic eye exercises, and a few go on to be helped by eye muscle surgery, called Strabismus or Squint surgery. It is essential to actively assess and treat issues associated with convergent strabismus at an early age, during the child’s critical period of visual development. We would recommend all children should have a formal sight test at age 4 onwards. With specialist skills it is possible to assess children from birth onwards, where there are any concerns about a possible squint or if there is a family history of glasses, amblyopia (lazy eye) or squint. Where concerns arise later than 7 years old, prompt and full assessment can be performed at any age.
At Clinica London we have Consultant Children´s Eye Doctors Ms Naomi Tan and Ms Naz Raoof, both of whom are experienced and caring. Specialising in Paediatric Ophthalmology and Strabismus, they both work closely with Clinica London´s four Orthoptists, Ms Leena Patel, Mr Greg Richardson, Mr Vijay Tailor and Mr Joe McQuillan, in the assessment and treatment of children with convergent eyes.
In this blog post, we will explore the causes, symptoms, and available treatments for abnormally convergent eyes – esotropia – in children.
Convergent strabismus can be caused by various factors, including:
Identifying convergent eyes in children can be crucial for early intervention, whether by glasses, orthoptic exercises or eye muscle surgery (strabismus surgery).
Common symptoms to watch for include:
The child with suspected convergent eyes should be seen by the orthoptist and then the paediatric ophthalmologist, Ms Naomi Tan or Ms Raoof, with both appointments usually on the same day.
The Orthoptist will measure the child´s vision in a friendly and age-appropriate way, using a series of pictures and specially designed, verified vision and stereopsis charts. They will check the fixation of each eye, and do tests with prisms, and look the eye movements in all the different positions of age.
Then special eyedrops are put in to make the pupils large. Paediatric Ophthalmologists Ms Tan or Ms Raoof will examine the back of the eye thoroughly to exclude any other pathology causing the eye to turn in, and do a test for glasses. Dilating eye drops are important to enable the ophthalmologist to assess whether the child or baby may need glasses (cycloplegic refraction). Dilating drops also enable a good view of the structures inside of the eye, the retina, macula and optic nerve to exclude any pathology which may be causing the eye to turn in.Eye drops take at least 25 minutes (and rarely can take over an hour) to work fully, so do come to clinic prepared with snacks and supplies to see your child through the various important steps of your visit.
Your consultant will review all the tests results and advise on the treatment.
Early detection, full assessment and appropriate treatment are crucial for managing convergent eyes in children.
Several treatment options exist, depending on the test results.
Convergent eyes, turned-in, or esotropia, can impact a child’s visual development, psychosocial development and overall quality of life. Early detection, eye tests, motility tests and refraction tests are required to make a proper diagnosis. Timely intervention by the Orthoptist and Paediatric Ophthalmologist is essential to manage this condition effectively. If you notice any signs of misaligned eyes or have other eye concerns in your child, it’s crucial to consult the eye care professional. Formal testing can be performed by specialist doctors from birth. With the right treatment approach, many children with convergent eyes can achieve improved eye alignment, better vision, and a brighter more confident future.
Our Consultant Paediatric Ophthalmologists are Ms Naomi Tan and Ms Naz Raoof, and our four Orthoptists are Ms Leena Patel, Mr Greg Richardson, Mr Vijay Tailor and Mr Joe McQuillan. They will all be delighted to help your child.
A child is not born able to see clearly, but develops their vision from birth (similarly to how they develop language) by having clear pathways of light into their eyes, light focusing well at the back of their eyes and the eyes being well aligned with each other. If all these things occur naturally, good vision tends to develop in both eyes. Children with convergent squints may not develop good vision in one of their eyes as a result of their squint – this is called amblyopia. They may appear to function perfectly well as they can see well with one eye, so the amblyopia may not be apparent to their parents and carers. It is important to have formal testing to check the vision of each eye separately. At Clinica London we want to help your child maximise their visual potential in both of their eyes whilst their vision is still developing. Sadly accidents and eye injuries can happen and developing good vision in both eyes is really important in mitigating the risk of blindness in later life.
Sometimes both eyes have weak vision as a result of needing quite strong glasses, and convergent squint may be the first visible sign of this to their parents and carers.
Amblyopia, often referred to as “lazy eye,” is a condition that occurs when the brain favours one eye over the other, leading to reduced visual acuity in the weaker eye. Abnormal convergent eyes – convergent strabismus or esotropia – play a crucial role in the development of amblyopia. In cases where one eye is significantly stronger with sharper vision, the brain may suppress the input from the weaker eye that sees less distinctly, resulting in visual imbalance. The weaker eye stays amblyopic and weak unless treated. Detecting and treating amblyopia early in childhood before the age of 5 years (and as early as possible) is essential to ensure proper visual development and prevent long-term visual impairments. There is still some flexibility or elasticity of vision development up to around 7 or 8 years, but the earlier age at which the amblyopia is detected and treated, the greater the visual results. Treating amblyopia can be challenging for families and at Clinica London we are here to support you, and to consider all the options to help your child reach their visual potential.
Tips to Maintain your kid´s eye health:
If you, a relative or a health care professional suspects your child has a convergent strabismus, (an esotropic squint) with one or both eyes looking inwards, for distance or near, even for only a short time, it is best to bring your child to a consultation with the orthoptist and ophthalmologist for eye and motility tests. They will do a full eye examination, measure the visual development, and advise accordingly.
If you would like your child to see Ms Naomi Tan or Ms Naz Raoof, please call 020 7935 7990.
Telephone: 020 7935 7990
International Callers : +44 20 7935 7990
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