Esotropia or crossed eyes

Approximately 13 million Americans suffer from strabismus, which affects approximately 4% of the population.

Esotropia or crossed eyes in Olympia


American Family Vision Clinic

Esotropia, commonly called crossed eyes, is a condition that affects 1-2 percent of the population whereby a person uses only one eye to look at objects while the other eye turns inward. Esotropia is a form of strabismus which is the inability of both eyes to align together to look at an object.

Symptoms of esotropia

Following are the common symptoms of esotropia:

  • You may have blurred or distorted vision due to inward deviation of eyes
  • You may look cross eyed
  • You may develop amblyopia (a condition in which vision is suppressed in one eye)
  • You may find it difficult to focus at an object that is nearby or at distance
  • You may find yourself reading or viewing an object with just one eye

Why do we need both of our eyes for great vision?

Esotropia or crossed eyes is not just a cosmetic issue, it deeply impacts many aspects of a person's life by disturbing their binocular vision. Binocular vision is the term that refers to the use of both of our eyes together to see the world. For a person with esotropia things that require both eyes working as a team become much more difficult. For example when we read, use a phone, drive a car, ride a bicycle, walk down the street, or play sports we use binocular vision to perform these tasks. When a functional optometrist works with an esotropic patient, the goal is to restore binocular vision.

Why do we need both of our eyes for great vision?

Dr. Levi Zurcher

Originally from Arizona, Levi received his Bachelor’s of Science in Zoology from Northern Arizona University and his Doctorate in Optometry from Pacific University in Oregon. He is board certified in developmental vision and vision therapy by COVD. He purchased the practice from the Inversos in 2012. He likes spending time with his family (wife and two children,) mountain biking, and undertaking creative projects. He wrote the vision therapy software used by the clinic, retinal camera software, and the computerized eye-chart used for exams.

What causes esotropia?

Our eye movements are controlled by extraocular muscles. These muscles keep our eyes aligned when we are looking at an object. If there is a problem with these muscles it may result in different types of eye misalignments such as esotropia.
A patient's family history may also contribute to this condition. Approximately 30% of children with strabismus have a family member with the same condition.
Esotropia can also be caused by:

  • Refractive errors such as farsightedness
  • Poor vision in one eye
  • Head injuries
  • Neurological issues such as down syndrome, cerebral palsy, hydrocephalus, brain tumors
  • Certain systemic diseases, like hyperthyroidism or diabetes

How is esotropia treated?

Esotropia must be detected and treated early in order to be effectively treated. During the early stages of development, the child's brain is adaptive and has a high chance of responding well to treatment. The good news is that there are effective treatments for esotropia for patients of all ages. Treatment of esotropia is determined on a case by case basis, where the functional optometrist will assess the underlying causes of the esotropia and the ideal treatment for that patient.

Treatment for esotropia involves treating the underlying cause, which may include:

  • Double vision
  • Weak extraocular muscles (responsible for eye movements)
  • Farsightedness (hyperopia)
  • Amblyopia (lazy eye)
  • Binocular vision dysfunction

Vision therapy: Vision therapy has been shown to be an effective, permanent, and non-invasive way to treat esotropia. The goal of vision therapy is to train the brain to use both eyes in tandem to achieve great vision. Vision therapy for esotropia is often done in combination with special prism lenses. The therapy is done in office under the guidance of the functional optometrist and a vision therapist. The in office sessions follow a series of repeated exercises,tailored to the patient's visual deficits and progress. You can schedule an eye exam for vision therapy with our developmental optometrist by calling (360) 491-2121.

Patching is another treatment option especially in patients with acquired esotropia caused by amblyopia. This option forces the brain to utilize the eye that has been ignored. For best results patching should be done in combination with vision therapy in order to promote binocular vision once the amblyopic eye is being used.

Surgery may be performed on your extraocular muscles to fix the misalignment of your eyes. It is performed by an ophthalmologist which may be recommended by our optometrist if necessary. Ideally surgery is done in combination with vision therapy, which allows for the combination of fixing the muscle alignment while reintegrating binocular vision for the patient through therapy.

With eyeglasses, accommodative esotropia can be treated by reducing focusing effort and convergence of the eyes.

Eyeglasses with prisms may also be prescribed to correct the misalignment of the eyes, effectively correcting esotropia.

Why do we need both of our eyes for great vision?

Types of esotropia

Intermittent esotropia

This type of esotropia does not cause eye deviation constantly. If a person has this type of esotropia, their eyes may deviate inward after doing near work for a long time.

Infantile esotropia

Infantile esotropia usually manifests within the first six to twelve months of life. Most children develop controlled eye movements before the age of 6 months, but they don't have them during the first few months of life. Esotropia in infants is evident by a large angle deviation. It is also associated with latent nystagmus.

Accommodative esotropia

Typically, this type of esotropia develops between 1 and 4 years of age. Initially, it is intermittent, but over time it becomes more frequent. It usually occurs in children who are more farsighted than usual. Their eyes have to work harder to see clearly when viewing an object that is up close. Due to this excess effort, the eyes become over-converged or crossed.

Acquired esotropia

Unlike esotropia that develops earlier in life, acquired esotropia develops later in life. It could be due to untreated hyperopia (inability to close up objects clearly), double vision, lazy eye (amblyopia) or diabetes.

Sensory esotropia

This type of esotropia occurs in children less than 4 years old. A child with impaired vision in one eye is most likely to suffer from this condition. To get clear vision, our brain must fuse images from both eyes. When one eye does not have good vision, it drifts inwards causing esotropia.

Dr. Zurcher cartoon


Esotropia is a form of strabismus in which one eye drifts inwards towards the nose while looking at an object that is closeby or at distance. There are many types of esotropia, which can be caused by double vision, amblyopia, hyperopia, weak extraocular muscles, or neurological conditions. Depending on the underlying cause, esotropia may be treated with eyeglasses, patching, vision therapy, surgery, and prisms. A vision therapy program can provide lasting effects and reduce the symptoms of esotropia and is often combined with other treatment options such as surgery or patching for better results. No matter how big or small your esotropia angle is, we can help you manage it and deal with it. You can schedule an eye exam for vision therapy (also called a functional or developmental eye exam) with our functional optometrist at American Family Vision Clinic by calling (360) 491-2121. Patients with eye alignment issues such as esotropia visit our clinic from all over Washington, and we are proud to be a leading provider of vision therapy services for patients from Olympia, Lakewood, Tacoma, and Lacey.


Such a nice optician. My grandson is only 4 and needs glasses. We were so sad, but he explained the issues, and we will follow up as he suggested.

Anna P.

I had such a good experience with the clinic. Very friendly staff and doctor, did not have to wait for long to be called, and was treated respectfully. Thanks, American Family.

June S.

Dr. Zurcher has gone above and beyond what any other eye doctor has ever done to figure out what is going on with my eyes. Very happy with American Family Vision.

Christine R.

Family Vision Clinic changed our lives! My daughter was frequently car sick, and she was getting headaches every day, often painful enough that they brought her to tears. We saw a string of doctors and therapists, but we made no progress. Finally, we found Dr. Levi Zurcher and his eye therapist Rain. After ten weeks of eye therapy my daughter no longer gets headaches, and she no longer gets car sick. Daily tears are a thing of the past. I really can’t say enough about this clinic. It was fascinating to watch Dr. Zurcher work. For the first time, someone who knew what they were doing was intently studying my daughter, really trying to figure out all of her eye issues, and his therapist Rain is one of the most patient and lovely people that I’ve ever had the good fortune to meet. We’re finished with eye therapy—yay!—and I have switched to American Family Vision Clinic for all of my family’s other eye health needs.

Lars Wulff

Very professional, yet kind and helpful. They do what they can to make the appointment comfortable. I was running a bit late, I made sure ti call. They were able to switch me with a patient who was already there, they treated me with respect, and helped my son have confidence by getting him the eye care he needed that day. Thank you so much! Would recommend to anyone. It's a blessing that they care enough to work with people who have all different types of insurance from work to state coverage.

Justin E.

The staff is friendly. The Doc is very knowledgeable. The office is family friendly and everyone is so patient with the little ones.

Amy Fagerness
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