Eye Misalignment in Children: Seeking Expert Advice

Strabismus

Hello Dr.
Chen, my daughter is currently one and a half years old.
She was diagnosed with left-sided torticollis at nine months old.
After undergoing rehabilitation, her head tilt is currently about five degrees.
However, when she looks straight at objects, her head involuntarily tilts.
We have consulted several specialists, but the differing diagnoses have left us quite confused.
I happened to come across your article on ocular misalignment and would like to ask for your opinion.
From the rehabilitation department: An ultrasound showed that the left neck muscles are shorter, and there are issues with the development of the vestibular semicircular canals, leading to the eye misalignment.
They suggested that as long as we continue rehabilitation, use a neck brace, provide visual tracking stimulation, and incorporate vestibular sensory activities, she can recover.
(Our concern is that the recovery time is long, the effects are slow, and we are uncertain if she will fully recover.)
From the ophthalmology department: There is a muscle paralysis in the lower left side, causing double vision, and she needs to look at objects from a specific angle to feel more comfortable.
They assessed that surgery on the eye is necessary; otherwise, there will be no chance of recovery.
(However, we are worried that surgery will definitely help.
If we do not opt for surgery, will there be any impact on her vision?)
From the pediatric surgery department: They believe that her pelvis is too small, which caused the fetus to habitually move more to the left during pregnancy.
They suggested that increased physical activity could lead to recovery, but they are uncertain when that might happen.
Could you please provide us with your advice, Dr.
Chen? Should we consult other specialties? Do you have any recommended hospitals? We sincerely appreciate your response.

Xinji Ruwen de Mami, 30~39 year old female. Ask Date: 2010/07/27

Dr. Chen Jianzhi reply Otolaryngology

Dear Inquirer,
Thank you for reading my paper published a few years ago.
However, it is important to note that ocular deviation can be classified into pathological and physiological types.
The pathological type must be differentiated from several common conditions, such as torticollis, strabismus, or others.
Based on your child's condition, it seems unlikely to be caused by a pathological ocular deviation, especially since a clear diagnosis has already been made by the ophthalmology department, while the assessments from rehabilitation and pediatric surgery are not definitive.
I recommend that you consult another ophthalmology specialist at a different hospital to determine if strabismus is indeed the cause.
If strabismus is confirmed, it would be best to consider surgical intervention to prevent amblyopia.
Sincerely,
Chen Jian-Zhi, Lecturer, Fu Jen Catholic University

Reply Date: 2010/07/27

More Info

Understanding eye misalignment in children, particularly in your case with your one-and-a-half-year-old daughter, is indeed a complex issue that requires a multidisciplinary approach. Based on the information you've provided, it seems that your daughter is experiencing a combination of physical and neurological challenges that are affecting her eye alignment and overall visual function. Here’s a comprehensive overview of the situation and some recommendations.

Diagnosis and Treatment Options
1. Multidisciplinary Approach: Given the varying opinions from rehabilitation specialists, ophthalmologists, and pediatric surgeons, it’s crucial to continue seeking a comprehensive evaluation. Each specialist offers valuable insights based on their expertise, but a coordinated approach is essential. Consider consulting a pediatric ophthalmologist who specializes in strabismus (eye misalignment) and can provide a holistic view of her condition.

2. Rehabilitation: The rehabilitation approach you mentioned, which includes ultrasound therapy for the neck muscles and vestibular stimulation, is a valid method to address the muscular and neurological components of her condition. While it may take time to see significant improvements, consistent therapy can lead to better outcomes. It’s important to remain patient and committed to the rehabilitation process, as muscle lengthening and coordination can take time.

3. Surgical Intervention: The recommendation for surgery from the ophthalmologist is a common consideration in cases of significant eye misalignment, especially if it is causing double vision or other visual disturbances. Surgery can realign the eye muscles and improve visual function. However, it’s essential to weigh the risks and benefits. Surgery does not guarantee complete resolution, and there may be a need for further interventions post-surgery. Discuss with the surgeon the likelihood of success based on her specific condition and the potential for developing amblyopia (lazy eye) if left untreated.

4. Monitoring for Amblyopia: One of the significant concerns with eye misalignment in children is the risk of amblyopia. If one eye is not aligned properly, the brain may begin to ignore signals from that eye, leading to reduced vision. Regular vision screenings are crucial to detect any signs of amblyopia early. If amblyopia is detected, treatments such as patching the stronger eye or using atropine drops to blur vision in the stronger eye may be recommended.

Recommendations for Further Action
1. Follow-Up Appointments: Schedule regular follow-ups with both the ophthalmologist and the rehabilitation specialist to monitor progress. Document any changes in her condition, including her ability to track objects and any changes in head posture.

2. Second Opinions: If you feel uncertain about the recommendations, seeking a second opinion from another pediatric ophthalmologist or a strabismus specialist can provide additional clarity and options.

3. Therapeutic Exercises: Engage in home exercises that promote visual tracking and coordination. Activities that encourage her to follow moving objects with her eyes can be beneficial. Consult with the rehabilitation specialist for specific exercises tailored to her needs.

4. Supportive Environment: Create an environment that encourages her to use both eyes effectively. Limit screen time and encourage activities that promote visual engagement, such as reading together or playing with toys that require her to look around.

5. Nutritional Support: While there is no specific diet that can correct eye misalignment, ensuring she has a balanced diet rich in vitamins A, C, and E, as well as omega-3 fatty acids, can support overall eye health.

Conclusion
Navigating the complexities of your daughter’s eye misalignment requires patience and persistence. By continuing to seek expert advice, engaging in rehabilitation, and monitoring her visual development closely, you can help her achieve the best possible outcome. It’s essential to maintain open communication with all healthcare providers involved in her care to ensure a coordinated approach. Remember, early intervention is key in managing eye conditions in children, and your proactive involvement will make a significant difference in her visual health.

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