1. Comitant (nonparalytic)-angle of deviation is constant in all directions of gaze

            A. Accommodative-hyperopic refractive error

            B. Nonaccommodative-refractive error not cause of deviation

            (1) Anomalous insertion of horizontally acting muscles

            (2) Abnormal check ligaments

            (3) Faulty innervational development

            (4) Autosomal recessive trait

            (5) Idiopathic

            (6) Tumor of the brain

             a. Cerebellar astrocytoma

             b. Pontine glioma

2. Noncomitant-the angle of deviation varies in different directions of gaze

            A. Abducens palsy (p. 161)

            B. Accommodative spasm

            C. Blowout fracture

            D. Divergence paralysis

            E. Drug use (marihuana)

            F. Duane syndrome

            G. Myasthenia gravis

            H. Thyroid myopathy

3. "V" pattern esotropia-deviation greater in downward gaze

            A. Underaction-superior oblique muscles

            B. Overaction-inferior oblique muscles

4. "A" pattern esotropia

            A. Underaction-inferior oblique muscles

5. Monocular esotropia-one eye may be used to the exclusion of the other; amblyopia is usual in the deviating eye

6. Esotropia-near/distance disparity

            A. High accommodation convergence-accommodation (AC/ A) ratio-greater convergence for   near than for distance, causing greater esodeviation for near than for distance

            B. Convergence excess-greater esodeviation for near than for distance

            C. Divergence insufficiency-greater esodeviation for distance than for near

Helveston EM. The origins of congenital esotropia. J Pediatr Ophthalmol Strabismus 1993; 30:215-232.

von Noorden GK. Binocular vision and ocular motility: theory and management of strabismus. St. Louis: CV Mosby, 1995.

Wright KW. Pediatric ophthalmology and strabismus. St. Louis: CV Mosby, 1995.

Williams AS, Hoyt CS. Acute comitant esotropia in children with brain tumors. Arch Ophthalmol 1989; 107:376.