Strabismus in Infants: When to Seek Treatment

Strabismus in children

Hello Dr.
Chen,
My baby girl is currently over 8 months old, but she often exhibits cross-eyed behavior.
Is this abnormal? Does she need to undergo correction, or will it likely resolve on its own as she gets older, perhaps after her first birthday? Also, is it too early to let her sit in a crab-shaped stroller?

Ann, 20~29 year old female. Ask Date: 2006/03/23

Dr. Chen Rongtai reply Pediatrics

The letter mentions that the baby is eight months old and sometimes exhibits cross-eyed behavior, which is actually known as esotropia, the most common type of strabismus.
In this condition, when viewing objects, one eye is aligned while the other deviates towards the nose.
In infants and young children, this may be a benign form of pseudostrabismus.
The reasons for this include: 1.
Infants tend to focus on nearby visual targets, causing the eyes to converge when looking at close objects.
2.
The bridge of the nose in infants is relatively wide, which can obscure the inner white part of the eyeball with the skin on the nasal side, making it appear as though the pupils are positioned towards the nose.
However, the coordination of the eyes is actually normal, and this condition typically resolves as the bridge of the nose develops and becomes more prominent.

Additionally, there are other pathological conditions that may also result in esotropia, such as neurological disorders, unilateral vision loss, paralysis of the lateral eye muscles, or intraocular diseases.
Therefore, it is advisable for parents to take their baby to an ophthalmologist for a thorough examination.
Regarding the use of a crab stroller, I do not recommend its current use; some orthopedic specialists suggest it is better to use it after the child turns one year old.

Reply Date: 2006/03/23

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 important for parents to understand when to seek treatment for this condition.

In infants, strabismus can be quite common, especially in the first few months of life. Many babies may exhibit some degree of misalignment as their eye muscles and coordination are still developing. However, if your baby is consistently showing signs of strabismus beyond the age of 4 to 6 months, it may be a cause for concern. By this age, the visual system is maturing, and persistent strabismus can lead to amblyopia, or "lazy eye," where the brain starts to ignore input from one eye, potentially leading to permanent vision problems.

In your case, since your baby is 8 months old and frequently exhibits signs of strabismus, it is advisable to consult with a pediatric ophthalmologist. They can conduct a thorough examination to determine the type and severity of the strabismus and recommend appropriate treatment options. Treatment may include glasses, patching therapy, or in some cases, surgery, depending on the specific diagnosis and severity of the condition.

As for your concern about whether your child will outgrow this condition, it is possible for some infants to naturally correct mild strabismus as they grow older. However, it is not guaranteed, and early intervention is crucial to prevent any long-term visual impairment. Therefore, it is better to err on the side of caution and seek a professional evaluation.

Regarding the use of a crab walker (a type of baby walker), it is generally recommended to avoid using walkers for infants. While they may seem like a fun way for babies to move around, they can pose safety risks and may hinder the development of natural walking skills. Instead, encourage your baby to practice crawling and standing with support, as these activities promote healthy motor development.

In summary, while some degree of strabismus can be normal in infants, persistent misalignment beyond 4 to 6 months should be evaluated by a specialist. Early diagnosis and treatment are key to ensuring your child's visual health. Additionally, consider avoiding the use of walkers and focus on activities that promote natural movement and development. Always consult with your pediatrician or a pediatric ophthalmologist for personalized advice and guidance.

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