Does My Toddler Have Crossed Eyes?

I recently noticed that when my 15-month-old daughter stares straight ahead, her left pupil turns inward, giving her a slightly cross-eyed appearance. I then examined all her photos, and found that she has had this condition since she was at least 12 weeks old. My pediatrician thinks that it might be a pseudosquint and advised me to see an eye doctor. How can an eye doctor effectively examine a 15 month old? Is it possible that this condition is merely cosmetic and won't affect her sight?

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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.

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.

There are several techniques physicians use to effectively assess the alignment of the eyes. The easiest (especially with a 15 month old) 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. I agree with your pediatrician in that if there is concern that your daughter has true strabismus, she needs an evaluation by the ophthalmologist. You can expect that doctor to carefully examine for strabismus using these tests as well as probably dilating the eyes to better examine the retina.

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