Eyes not accommodating
As time passes the problem typically worsens causing the eyes to cross more often.
A child who has accommodative esotropia almost always chooses one eye to keep straight, the dominant eye. Accommodative esotropia is most always treated with glasses.
Loss of the parasympathetic signal causes the pupil to dilate.
20/20 has always been the "holy grail" to the Optometric field.
In fact, vision therapy is 85% successful for Exotropes (eye turns away from nose) and 75% successful for Esotropes (eye turns in towards nose)l.
Recent studies indicate that Strabismus surgery actually reduces the success rates of the Strabismus vision therapy by 25%. Surgery only fixes the mechanical problem, the eye turn. So, if surgery is done on a patient with vision disorders resulting from Strabismus, then vision therapy is the only way to regain proper vision in that eye, regardless of surgery.
The crossed, non-dominant eye almost always loses vision because of disuse. Glasses will only help the child if they are prescribed accurately and worn full-time.
In convergence insufficiency, eye misalignment occurs when focusing at near.This is present in up to 20% of normal people and termed physiological anisocoria. Back to the abnormally large pupil termed a mydriasis.The autonomic nervous system controls pupil movement, with constriction supplied by the parasympathetic fibers which travel with the 3rd cranial nerve.This also causes lose of depth perception or 3D vision.