My Child’s Eyes Are Not Straight

Early detection of eye problems in children is critical for normal visual development. The first few years of life are very important for both monocular (one eye) acuity and binocular (two eyes working together) acuity. Delay in detection of eye problems in children can have lasting negative effects on their vision so it is key to know what is and what is not ‘normal’.

During the first three months of life, some eye crossing or eye wandering can be within normal limits. However, if there is a constant eye cross (esotropia) or wander (exotropia) it is important to rule out underlying pathology, even at this young age. To recap- an intermittent eye turn in the first 3 months of life is within normal limits but any constant eye deviation needs to be evaluated by a Pediatric Ophthalmologist.

After 3 months of age, any eye misalignment (intermittent or constant) is not normal and needs to be evaluated. Parents are sometimes told ‘they will grow out of it’, but if there is a true eye deviation present this is abnormal beyond three months of age and the child needs to be seen by a Pediatric Ophthalmologist.

Some children, especially infants and toddlers often have an appearance of an eye turn when in fact their eyes are straight. This is called pseudostrabismus and is due to the fact that the face of an infant or toddler is different than that of an adult. Oftentimes the shape of the eyelids produces the false impression of eye misalignment, especially in photographs. However it is better to be safe than sorry, so if there is any question as to whether a child’s eyes are aligned or not it is better to have them evaluated.

A detailed review of strabismus (eye misalignment) is beyond the scope of this blog but conceptually the goal of treatment is to align the eyes and improve/equalize the vision between the two eyes. Each child is different, but treatment may entail glasses, patching, drops or sometimes eye muscle surgery.

Some final comments. Any eye misalignment that starts after age 5 years is especially worrisome and requires prompt evaluation. Regardless of age if the eye misalignment is associated with severe headaches or nausea, double vision, or reduced lateral eye movements immediate evaluation by a Pediatric Ophthalmologist is indicated.

Post by Darron A. Bacal, MD, FAAP. Dr. Bacal is a specialist in Pediatric Ophthalmology and Adult Strabismus. He is the Chair of Professional Education for the American Association for Pediatric Ophthalmology & Strabismus and an Assistant Clinical Professor @ Yale New Haven. For more information about treatment, or any of the services we offer, contact us at any of our 4 offices in Milford, Orange, Branford, or Shelton. We’re looking forward to hearing from you soon.

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