Help: My Babies Eye's Are Not Straight!

At some time or another every mother fears that there is something wrong with her child's eyes. This concern might be due to something as basic as a case of "pink eye" infection or common ragweed eye allergy but the biggest fear occurs when a mother thinks her child’s eyesight might be threatened. By far the most common reason for young children's eye examinations is the fear of a "turned" or misaligned eye. A turned eye is a vision threatening condition with high risk of developing a permanent visual disability. With around 5 percent of the U.S. population under six having a turned eye, early diagnosis is critical.

The condition where an eye is turned is more properly known as strabismus and often first appears between birth and age 21 months. Around 50 percent of children with strabismus are born with the early signs. Esotropia (eyes that turn in) are by far the most common childhood strabismus. Infantile strabismus is the most frequent esotropia in young children and is often associated with a family history of turned eyes. In infantile strabismus the eye turn is usually very large and very noticeable in the babies first six to twelve months. There is a high risk of developing poor vision in the turned eye at such a formative age so early diagnosis is even more critical. Strabismus is the most common cause of amblyopia (lazy eye), which is the most frequent cause of monocular vision loss in people between 10 and 70 years of age. So despite some old wives’ tales, children don't outgrow strabismus or its effects and the condition almost always worsens without treatment.

Why then, if only a few percent of the population is affected by infantile strabismus, do we see a much larger percentage of babies and toddlers having an early eye examination? The answer is that a young child’s eyes often look turned even when they are not! The weak eye muscles of newborn babies struggle to align and most parents don’t realize that children’s eyes can look temporarily crossed till full control of eye movements develops around ten months of age. Another frequent presenting condition that can make a child’s eyes look turned in is called pseudo-esotropia.

A very small percentage of the population is affected by infantile strabismus

Pseudo-esotropia is the name that describes normal eyes appearing to turn in toward the nose due to the shape of a baby or toddler’s face. Infants often have flat broad bridged noses with wide nasal skin flaps (known as epicanthal folds). This makes their eyes look narrow and turned in compared to the overall shape of their face. As the child’s face grows the folds slowly decrease and the eyes begin to look straighter with normal development. Fortunately pseudo-esotropia has no effect on vision and an eye care practitioner can quickly tell the difference between the two with a simple corneal reflex torch test.

Poor vision is not the only problem that will result from uncorrected infantile esotropia. Cross-eyed children often grow up socially disadvantaged. The poor cosmetic appearance of a turned eye can often make adolescent dating and relationships awkward. Some occupations require good quality vision in both eyes so a lazy or turned eye may exclude your child from a range of future occupations.

Treatment options for infantile esotropia are limited. Surgical realignment of the affected eye muscles usually needs to be carried out at an early age, often before the child is two years old and in bad cases sometimes as young as six months old. As well as surgery there is usually a need to treat the amblyopia (lazy eye) vision problem by "patching" the good eye and forcing the lazy eye to work better.

So if your young baby’s eyes sometimes don't look straight the first thing is "Don't Panic!" In most cases it is a temporary misalignment of the eye muscles or pseudo-esotropia but if the turn persists for more than a few days then it is important to quickly have it checked out by your eye care practitioner. A few minutes checking now might save your baby a lifetime of grief!