Someone with esotropia will squint with either the right or the left eye but never with both eyes simultaneously.

In a left esotropia, the left eye 'squints,' and in a right esotropia the right eye 'squints.' In an alternating esotropia, the patient is able to alternate fixation between their right and left eye so that at one moment the right eye fixates and the left eye turns inward, and at the next the left eye fixates and the right turns inward.

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The condition can be constantly present, or occur intermittently, and can give the affected individual a "cross-eyed" appearance.

It is the opposite of exotropia and usually involves more severe axis deviation than esophoria.

Concomitant esotropias can arise as an initial problem, in which case they are designated as 'Primary,' as a consequence of loss or impairment of vision, in which case they are designated as 'Secondary,' or following overcorrection of an initial Exotropia in which case they are described as being 'Consecutive'. Concomitant esotropia – that is, an inward squint that does not vary with the direction of gaze – mostly sets in before 12 months of age (this constitutes 40% of all strabismus cases) or at the age of three or four.

Most patients with "early-onset" concomitant esotropia are emmetropic, whereas most of the "later-onset" patients are hyperopic.

This alteration between the left and right eye is mostly spontaneous, but may be voluntary in some cases.

Where a patient tends to consistently fixate with one eye and squint with the other, the eye that squints is likely to develop some amblyopia.

Esotropia is sometimes erroneously called "lazy eye", which describes the condition of amblyopia—a reduction in vision of one or both eyes that is not the result of any pathology of the eye and cannot be resolved by the use of corrective lenses.

Amblyopia can, however, arise as a result of esotropia occurring in childhood: In order to relieve symptoms of diplopia or double vision, the child's brain will ignore or "suppress" the image from the esotropic eye, which when allowed to continue untreated will lead to the development of amblyopia.

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