Baby is cross-eyed: Will this correct itself?

Our 12-week-old baby is still cross-eyed. His doctor said that he may require tests, as this should have corrected itself by now. Is there a chance this could still correct itself?

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Robert Steele

Robert W. Steele, MD, is a board certified pediatrician at St. John's Regional Health Center in Springfield, MO. He graduated from medical... Read more

Strabismus, or misalignment of the eyes, is a common condition encountered in children. In fact, it may effect up to four percent of all children younger than six years of age. This disorder can disable sight in one eye and have significant psychological effects as well. Thus, restoration of the proper alignment of the eyes at an early stage of visual development is crucial.

The eyes crossing is rather common and considered normal under two months of age. However, if the eyes continue to cross when the child is three and four months of age, then the conditions of exotropia (eyes moving outward) or esoptropia (eyes crossing inward) become more of a concern. I agree with your pediatrician. If there is concern that your child has true strabismus, esotropia, or exotropia, an evaluation by the ophthalmologist is necessary.

A common misconception is that children with crossed eyes will outgrow the condition. This belief probably got started from the confusion between true strabismus and what is called "pseudostrabismus" or "pseudosquint."

Pseudostrabismus is an optical illusion in which normal aligned eyes appear crossed due to an optical illusion. This appearance may be due to a wide, flat nasal bridge and/or prominent skin folds at the inner eyelids. These characteristics hide a portion of the white part of the eye creating the impression that one eye is turned toward the nose. This appearance resolves as the child gets older and causes no visual problems.

Next: The exam and treatment
There are several techniques physicians use to effectively assess the alignment of the eyes. The easiest is called the corneal light reflex test. This is done by shining a light at the eyes and observing where the light reflection falls on each eye. They should be symmetrical. The other is done by covering and uncovering the eyes in a certain manner and watching for drift or movement of the eyes. The latter test takes a little cooperation from the child, but an inventive pediatrician or pediatric ophthalmologist can come up with a few tricks to pull this test off and actually make it fun for the child.

When the ophthalmologist evaluates a child for strabismus, he is looking to detect several things including alignment of the eyes, visual acuity, and depth perception. Essentially, he is trying to find out if the eyes are working together to provide clear images with depth perception. Each strategy to treat strabismus has the goal of correcting any vision deficits by at least two years of age. The severity of the deficit dictates what measures are taken to correct vision.

The most common treatments for strabismus are:

  1. Corrective lenses (glasses) -- Some strabismus may be caused by the child moving her eyes voluntarily (but subconsciously) in an attempt to overcome a defect in the eye lens. By correcting the defect through wearing glasses, the strabismus is corrected as well.
  2. Patching -- A patch is applied over the "good" eye. This forces the "bad" one to work correctly. The patch is continued until correct vision is restored. As the vision defect is corrected by this method, the strabismus is corrected as well.
  3. Surgery -- There are generally two techniques that are employed to surgically correct strabismus. One strategy involves taking the eye muscle responsible for causing the strabismus and moving it to a different attachment location on the eyeball. The other technique is to cut out a portion of the muscle effectively shortening it. Either operation allows for the eye muscle to pull the eyeball into the correct position. Because the eyes work together to provide correct vision, some severe forms of strabismus may require surgery to both eyes.

While there are several options of treatment for strabismus, the best option will depend upon the specific mechanism that is causing it. Once the cause and severity is determined, your doctor should list the available options and recommendations for your daughter.

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