Have you or your child been diagnosed with accommodative esotropia?

What Is Accommodative Esotropia?

Accommodative esotropia is an eye condition in children where the eyes turn inward relative to one another, especially when the child is focusing on something up close, like reading or drawing. This inward turning happens because of excessive stress on the muscles the eyes use to focus clearly, which can make the eyes turn inappropriately close.

The vast majority children with accommodative esotropia are excessively farsighted, which means their eyes have to work harder than normal to see clearly—especially up close. When their eyes focus, it also pulls the positioning eye muscles to turn inward. For these kids, that inward pull is stronger than it should be, which makes the eyes cross. Most children with accommodative esotropia will be prescribed glasses to help reduce or eliminate the eye turn. These glasses correct the farsightedness and reduce the effort their eyes need to focus.

It's very common for children to not appear to have any vision problems or have any complaints. That’s because children often don’t realize they are seeing differently than they should be. They may still function well, and the eye turn might only happen sometimes. Glasses are often still needed to help their eyes focus properly. The goal is not just clearer vision, but to help the eyes align correctly and work together comfortably.

Treatment for Accommodative Esotropia

The most common treatment is bifocal glasses, which have a special section in the lower part of the lens that makes focusing on near objects even easier. This helps prevent the eyes from turning inward when doing things like reading, coloring, or using a tablet. Bifocals are especially helpful for younger children or those whose eyes still tend to cross when doing close-up activities, even with regular glasses.

Once your child starts wearing glasses, we will schedule regular follow-up visits to:

• Check how well the glasses are working

• Monitor the alignment of the eyes

• Adjust the prescription as your child grows

These check-ins are usually every 3-6 months at first. Children grow quickly, and so do their eyes — regular care is the key to making sure the eyes are developing properly and working well together.

It’s important to minimize screen time. Focus on developing strong gross and fine motor skills, as these activities support healthy visual development (climbing at the playground, playing catch, coloring, using scissors, building with blocks, and threading beads, etc.).

If there is no additional improvement in the alignment of the eyes or the child’s visual comfort, the next step of treatment may be vision therapy.

Vision Therapy

Vision therapy is a structured program of in-office and at-home activities that help the brain and eyes learn to work better together. It can improve eye teaming and coordination, control over the eye turn, depth perception, reading comfort and attention.

What is Vision Therapy?

Vision therapy is a customized program of eye–brain exercises that helps children improve how their eyes work together. It’s designed to train the brain to coordinate both eyes effectively for clear, comfortable, and efficient vision—especially during activities like reading, writing, and paying attention in class. It focuses on strengthening visual skills such as eye coordination, depth perception, tracking, and focusing—skills that are essential for learning and everyday tasks.

What it looks like:

• Weekly office sessions: Typically one hour per week.

• At-home activities: 15–20 minutes of practice per day to support progress.

• Progress checks: Regular evaluations to monitor changes and adjust goals.

• Family support: Parents receive guidance to help reinforce skills at home.

Cost and Insurance: Vision therapy at our office is not usually covered by medical insurance or vision insurance, but our office offers affordable payment plans to make care accessible.

Ready to get started?

If you’re ready to get started with vision therapy, or have any questions, the best way to reach us is by texting our office (253-201-2515)—it’s quick, easy, and our preferred method of communication. You’re also welcome to call or email if you prefer. Please note that we typically have a 2–4 month wait time to begin therapy due to limited availability. Our sessions are offered Tuesday through Friday. We’ll be happy to answer any questions and help reserve a spot for your child as soon as possible!

Do you need treatment for strabismus or amblyopia in the Kent, Auburn, Renton, Covington, Maple Valley, Enumclaw, or Black Diamond area?

Schedule an eye exam today!