Strabismus in Infants: Concerns and Management

Strabismus in infants

Hello Doctor: I would like to ask you a question.
My child is currently one year and one month old.
Recently, over the past two weeks, I have noticed that when he looks straight ahead at a distance or when he is about to sleep, his right eye tends to drift outward.
I am concerned that he may have exotropia.
We consulted a pediatrician who said that his vision appears to be normal and suggested monitoring him for three months.
However, if he does have strabismus during this three-month period, will it affect his vision? Additionally, are there any methods to prevent the condition from worsening?

alin, 30~39 year old female. Ask Date: 2005/02/14

Dr. Feng Jiefan reply Ophthalmology

Hello,
For a child who is one year and one month old, it is generally understood that their development is not yet complete, and occasional strabismus may occur.
This is often not a cause for concern if it happens infrequently; continued observation is usually sufficient.
However, if it occurs persistently, especially if it is esotropia (crossed eyes), it is advisable to seek assistance from a pediatric ophthalmologist promptly.
Sometimes, a child may appear to have strabismus, but it may not be a true case of strabismus; a thorough examination with appropriate instruments by a physician is necessary for an accurate diagnosis.
Based on your description, it would be reasonable to continue monitoring the situation.
If you remain concerned, a follow-up visit to the hospital for reassessment can help confirm the diagnosis.
Sincerely,
Dr.
Feng Chieh-Fan, Ophthalmology

Reply Date: 2005/02/14

More Info

Strabismus, commonly known as "crossed eyes" or "squint," is a condition where the eyes do not properly align with each other when looking at an object. It can occur in infants and young children, and it is understandable for parents to be concerned about its implications on vision and overall development.
In your case, your child is showing signs of an outward deviation of the right eye when looking straight ahead or when sleepy. This condition can be classified as exotropia, which is a type of strabismus where one or both eyes turn outward. The first step in managing strabismus is to ensure that a thorough eye examination is conducted by a pediatric ophthalmologist. It is reassuring that the doctor has indicated that your child’s vision appears normal at this time, but it is essential to continue monitoring the situation.

One of the primary concerns with strabismus in infants is the potential impact on visual development. If strabismus is present, especially if it is constant, it can lead to amblyopia, commonly known as "lazy eye." Amblyopia occurs when the brain starts to favor one eye over the other, which can result in reduced vision in the affected eye. Early detection and intervention are crucial to prevent long-term visual impairment.

The recommendation to observe your child for three months is a common approach, as some children may outgrow mild forms of strabismus as their visual system matures. However, if you notice that the strabismus persists or worsens during this observation period, it is essential to follow up with your healthcare provider sooner rather than later.
In terms of management, there are several strategies that can be employed depending on the severity and type of strabismus:
1. Vision Therapy: This involves exercises designed to improve coordination and focusing abilities of the eyes. A pediatric ophthalmologist can provide specific exercises tailored to your child's needs.

2. Corrective Lenses: In some cases, glasses may be prescribed to help align the eyes or improve vision.

3. Patching Therapy: If amblyopia is detected, patching the stronger eye can help strengthen the weaker eye by forcing it to work harder.

4. Surgery: In more severe cases, surgical intervention may be necessary to realign the eyes. This is typically considered when other treatments have not been effective.

5. Regular Monitoring: Regular follow-up appointments with an eye specialist are crucial to monitor the condition and adjust treatment as necessary.

As a parent, you can also support your child's visual development by engaging in activities that promote visual tracking and coordination. Encourage your child to look at objects of varying distances and play with toys that require focusing and reaching.
In conclusion, while it is common for infants to exhibit some degree of strabismus, especially as their visual system develops, it is essential to monitor the condition closely. If you have any concerns about your child's eye alignment or vision, do not hesitate to seek further evaluation from a pediatric ophthalmologist. Early intervention can make a significant difference in the long-term visual outcomes for your child.

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