Turned or Crossed Eye: Can a Baby Outgrow Strabismus?

By Heikki Siltala or catza.net (KES-KIS cat show Jämsä 2014-06-14) [CC BY 3.0 (http://creativecommons.org/licenses/by/3.0)], via Wikimedia Commons

Each eye sits in the middle of six muscles. These muscles are great at teamwork and help make sure that both eyes are looking at the same thing at all times. With turned or crossed eye, however, the muscles don’t work together as they should. Instead, the eyes each work on their own, and are focused on different objects.

With normal eyesight, the brain is sent just one image. In turned or crossed eye, the brain is sent two different images. This is confusing and many children learn to ignore one of the images, the one from the weaker eye. It’s just easier for a person to see one image, so the brain shuts out the second image.

In some children, lazy eye comes first, and causes the strabismus, the turned or crossed eye. Most of the time, however, no one knows what causes turned or crossed eye. What we do know is that in over half of the time, babies are born with strabismus, or have it not long after they are born. When this happens, doctors call it congenital strabismus.

While there is a weaker eye in a case of turned or crossed eye, the problem is in controlling the eye muscles and not so much about the strength of the eye muscles. There are also certain medical conditions that make children more prone to strabismus, including:

• Apert syndrome
• Cerebral palsy
• Congenital rubella
• Hemangioma near the eye during infancy
• Incontinentia pigmenti syndrome
• Noonan syndrome
• Prader-Willi syndrome
• Retinopathy of prematurity
• Retinoblastoma
• Traumatic brain injury
• Trisomy 18

For some people, turned or crossed eye just seems to run in the family. Farsightedness may also contribute to turned or crossed eye. In general, any condition that brings on vision loss can also cause strabismus.

The symptoms of turned or crossed eye may come and go or be present at all times. When the signs come and go, parents might wrongly think that a baby will outgrow strabismus. It’s important for parents to realize that a baby doesn’t outgrow turned or crossed eye, and if parents don’t treat the condition, the baby might lose vision in that eye for good.

Symptoms of Turned or Crossed Eye

In a baby, the main signs of turned or crossed eye are:

• Eyes don’t move together
• Eyes don’t line up to look in the same direction
• Crossed eyes
• Head tilt or turn
• Squinting

An older child may be able to tell you that she is seeing double, losing vision in one eye, or having trouble with Depth Perception. Depth perception is knowing how far or close you are to an object and seeing things in three dimensions (3D vision). If your older child reaches out for a glass of water and knocks it over and this happens a lot, it might be a sign of strabismus.

If you think your baby or child has strabismus, take her for a good eye exam. The doctor or health care professional will do tests to see how far the eyes are out of sync with each other. Tests for turned or crossed eye include:

• Testing how the cornea reacts to light
• Cover/uncover test
• Exam of the retina
• Standard eye exam
• Vision exam
• Measuring nerve and brain responses (neurological exam)

Treatment for Turned or Crossed Eye

Almost always, the treatment for turned or crossed eye is surgery and the sooner it is done, the better. If you wait too long, your baby or child might end up with some degree of permanent vision loss. The surgery for turned or crossed eye (strabismus) makes the muscles that surround the eye either weaker or stronger. This will help the eyes work together.

The younger the child is, the more successful the surgery. In some cases, a child will need to wear glasses even after surgery. Some children will need surgery more than once to fix the turned or crossed eye.

The American Association for Pediatric Ophthalmology and Strabismus believes that around 4 percent of the U.S. population has a turned or crossed eye. A newborn baby may have crossed eyes as his vision is not finished developing. But this passes within a few weeks. True strabismus doesn’t “pass” or go away, and is never outgrown.

You want to catch strabismus early, because treating the condition as early as possible offers the most successful outcome. When turned or crossed eye is ignored, a child can develop double vision or lazy eye. Developing these vision problems can make it hard for a child to read and do well in the classroom later on.

Your baby’s pediatrician will probably notice it if she has a turned or crossed eye, and will tell you to see an ophthalmologist that is experienced in strabismus surgery. If you suspect your baby has a turned or crossed eye, you can schedule an appointment with the baby doctor to talk about your concerns. No matter who notices it first, you or your baby’s doctor, remember that the only real treatment for strabismus is surgery.

Surgery on a baby’s eye can sound scary. But losing vision in an eye is a lot scarier and can make or break a child’s performance in school later on. One-third of children with strabismus go on to develop amblyopia. If amblyopia isn’t treated by age 11, it will almost certainly become a permanent condition. Early treatment of strabismus, on the other hand, is almost always successful.

A number of children will develop a turned or crossed eye after surgery and will need to have surgery again. For this reason, you have to really watch kids who have surgery for turned or crossed eye, because the tendency to get it again, is there.

When talking to the doctor or surgeon, you may want to ask the following questions:

• Will one surgery fix the problem, or will my child need more surgeries?
• What’s your success rate for repairing strabismus?
• Will the surgery improve my child’s appearance and vision?
• How much of the treatment for strabismus is covered by health insurance?

The main thing to remember with a turned or crossed eye is that it isn’t something that is outgrown. Protecting your child’s eyesight and preventing learning problems means seeing a doctor and getting treatment as soon as you can. Relax: this is something that can be fixed, as long as you get to it ASAP (as soon as possible).