Intermittent Esotropia in Infancy

Normal Visual Development

Intermittent esotropia during the first 3 months of life is normal and does not necessarily predict the development of constant strabismus 1
Some degree of intermittent eye misalignment is considered a normal part of visual development during the first 3 months of life 2

Family history of strabismus is a risk factor for developing persistent strabismus 3
Premature birth, especially with birth weight under 2000 grams, is a risk factor for developing persistent strabismus 3
Neurodevelopmental impairment is a risk factor for developing persistent strabismus 3
Significant hyperopia (farsightedness) is a risk factor for developing persistent strabismus 3
Low birth weight or low Apgar scores are risk factors for developing persistent strabismus 3
Exposure to smoking or alcohol in utero is a risk factor for developing persistent strabismus 3
Craniofacial or chromosomal anomalies are risk factors for developing persistent strabismus 3

If the eye crossing is intermittent and variable at 2 months, continued observation is appropriate 3
Most cases of intermittent esotropia in the first 3 months resolve spontaneously 2
If esotropia persists beyond 3-4 months, becomes constant, or is associated with other concerns, ophthalmological evaluation is recommended 1
Early diagnosis and treatment are essential if strabismus persists, as binocular vision can degrade rapidly in young children 5

Persistent strabismus can lead to amblyopia (lazy eye) if left untreated 2
Early treatment promotes binocular vision and improves visual function in each eye 6
Proper alignment is important for normal visual development and social interactions 6

Intermittent eye crossing at 2 months of age is typically normal 1
Monitor whether the crossing becomes more frequent or constant 2
If the crossing persists beyond 3-4 months, becomes constant, or is associated with other concerns, seek ophthalmological evaluation 3
Early intervention is important if true strabismus develops to prevent long-term visual impairment 6