While newborns’ eyes can at first appear misaligned, most straighten within the first few months of life. But if parents start to notice babies’ eyes crossing or wandering outward, upward or downward, it could be serious.
The first step is to find a pediatric ophthalmologist who can rule out a problem.
“The first thing we need to do is make an accurate diagnosis,” said Craig A. McKeown, M.D., professor of clinical ophthalmology at Bascom Palmer Eye Institute at University of Miami Miller School of Medicine.
He recommends selecting a specialist from the National Organization of Pediatric Ophthalmologists.
In rare cases, a child could have an eye tumor, called a retinoblastoma, McKeown said.
But typically, the diagnosis is strabismus, a misalignment of the eyes. About 4 percent of U.S. children have strabismus, according to the American Academy of Ophthalmology.
Strabismus can lead to reduced vision or amblyopia, vision loss.
“Amblyopia is the leading cause for reversible blindness in young people,” said Arlanna N. Moshfeghi, M.D., assistant professor of clinical ophthalmology at Bascom Palmer Eye Institute in Palm Beach Gardens.
Strabismus can be treated early through a variety of methods or a combination, including glasses, therapy, patching and, in some cases, surgery.
There are different types of strabismus, and the type determines treatment. For example, esotropic strabismus is when eyes turn inward, or cross. Sometimes kids’ eyes cross when they focus too hard, and glasses may help.
“If you take away the patient’s need to focus so hard, you take away the need to cross,” said Bruce Miller, M.D., of Pediatric Ophthalmology Consultants of South Florida.
Glasses may be prescribed along with patching one eye or alternating eyes with bandage-type coverings several hours a day.
A child’s vision is constantly developing until about age 8. During that time, if a child starts losing vision in one eye, the brain may ignore that eye and instead focus attention on the other, Moshfeghi said.
“The brain will tend to shut off vision in one eye or even fail to develop vision,” McKeown said. “You have to have to use vision to develop good vision.”
Moshfeghi explains, “That eye can lose the potential for becoming 20/20. With patching, it’s forcing the brain to pay attention to the eye it’s ignoring, reversing the amblyopia.”
Johanna Shields, of Fort Lauderdale, intermittently spotted a different form of strabismus called exotropia in her daughter’s eyes when Ashley was 3 months old.
“I would notice it; and then I wouldn’t notice it,” Shields recalled.
Exotropia, which is when eyes turn outward, and can be treated by surgically tightening or loosening muscles so that eyes work together, Miller said.
Shields said she consulted with one pediatric ophthalmologist, but during several months, that doctor did not diagnose a problem.
“I remember thinking, ‘I’m not crazy. I know I’m seeing it,’” Shields said.
She sought a second opinion. Since then, her daughter, and her twin daughter Brooke, have had strabismus surgery.
“Trust your gut,” Shields said. “Do your research. Ask your questions. Make them listen to you.”
While some cases of strabismus can be obvious, others may be subtle. Parents may notice children squinting a lot in the light or tilting their head to see.
Joyce Moberg said her daughter Hope’s strabismus was more noticeable in photos.
“Be an aware parent,” said Moberg, of Deerfield Beach. “If you feel very adamant that something is not right, listen to that gut feeling. Find that doctor that is going to listen to you.”
In about 10 to 15 percent of cases, as in Hope’s, a child may undergo more than one surgery if eyes drift again.
Parents may have the power of prevention through intervention, Moshfeghi said.
“If parent sees an eye drooping or an eye turns in, bring the child to a pediatric ophthalmologist. If you have a strong family history of glasses, bring a child in,” Moshfeghi said. “The only really way to be safe is to take the power in your hand and go to the eye doctor and have your child’s vision checked.”Copyright © 2015, Los Angeles Times