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Stefan, let me try to elaborate on your question and concerns. First of all, let me say that I would expect this to happen. Let's start by talking about why your son's eyes do what they do.
Accommodation and convergence are intimately tied in reflex arcs, one in particular which is called the near reflex. When you look at a near object, three things happen simultaneously on reflex: accommodation, convergence, and miosis (pupil constriction). Children who have the type of strabismus (eye misalignment) called esotropia (misalignment of the eyes in an inward, or toward the nose, direction) can have a completely accommodative esotropia [meaning their eyes turn in because they are trying to overcome a moderate to severe amount of hyperopia (farsightedness or hypermetropia) that is not corrected by glasses], a partially accommodative esotropia, or a non-accommodative esotropia. Those with non-accommodative esotropias have some problem within their brain that is not tied to a significant need for glasses (in other words, is not caused by accommodative strain) that still causes their eyes to turn in. For those people we don't know why this is the way it is. However, many children with esotropia have it, at least in part, because they have an excessive amount of farsightedness. Your son, as you have already stated, is one of those.
I suspect that you are this way as well. The accommodative and convergence systems do still coordinate in this way throughout life, but your ability to accommodate (because of stiffening and hardening of your natural, crystalline lens) diminishes significantly as you age, ultimately causing presbyopia. But the coordination and reflex itself does not diminish, only the ability of the lens to appropriately respond to the accommodative effort, as it did when you were younger.
I think you have a non-accommodative esotropia, or an esotropia that is not caused by significant hyperopia. Presbyopia is not known to cause esotropia.
Please ignore the last two paragraphs in my prior post (that start with, "I suspect that you are..." and "I think you have a non-accommodative..." I'll continue from where I left off prior to changing to the Q&A format.
Your description of his eyes being mostly straight (aligned) with his glasses on is a good thing and I would hope and expect this to be the case. What this says is that the high hypermetropia is responsible for the majority of his eye turning in and once his brain does not have to push his eyes to focus through that high hypermetropia (by wearing the glasses), his near trial/reflex can function more normally and not cause the eyes to slip inward when he looks at something up close.
However, now that your son is on atropine (in his good eye, the eye that does a lot of the visual work), it is as though some hyperopia is being added to the equation because the atropine interrupts the ability of the good eye to focus up close, so once again the slipping of that eye inward when he activates the near reflex occurs.
Because that reflex doesn't exist for viewing objects in the distance, I wouldn't expect it to occur for distance vision, only for near.
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My opinion is solely informative and does not constitute a formal medical opinion or recommendation. For a formal medical opinion and/or recommendation you must see an eye doctor. Thanks for your inquiry!
So is the slipping inward of the left eye when on atropine damaging in the long run? Meaning, is this safe? Should I be concerned or discontinue the treatment?
Thanks for your reply. It helped alot.
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