The deviation in infantile esotropia is large - greater than 50 dioptres - and usually concomitant. Vertical deviations are common. Abduction may be limited but normally is demonstrable. There is frequently nystagmus. Often, there is hypermetropia. Amblyopia is common, especially if there is anisometropia.
There may be a short period during which there is spontaneous alternation of fixation, implying near equal vision in both eyes. Commonly, the deviation tends to become monocular, with the eye that appears straight, being used for fixation and having better vision or lower refractive error. Sometimes, there is cross-fixation with the left eye being used to look to the right and the right eye, to the left. This is more common in large angle esotropia and may be confused with a bilateral lateral rectus palsy. However, ocular movements are full when one eye is covered to prevent cross-fixation.
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