Children’s Eye Problems

Strabismus simply means eye misalignment. (Some people refer to this as “lazy eye,” but others mean different things when they use that term.) Strabismus may be horizontal (inward or outward) or vertical.

Horizontal Eye Misalignment
Esotropia - Some children have a large amount of crossing from very early infancy, with onset before six months of age and no improvement after that age. This is called congenital esotropia. Examination often shows that these children are not farsighted enough for glasses to help straighten the eyes, so that early surgery is required to make the eyes straight and to allow the brain to learn to use them together. Many of these children spontaneously “alternate” (meaning that one eye turns in as often as the other), but if it is consistently the same eye that is crossing, then the other eye may need patching before surgery is done. (It is important to understand that patching does not, and is not intended to, fix the crossing. The purpose of the patching is to improve the vision of the eye that does not see as well.)

More commonly, the eyes are straight at birth, but then begin to cross at about age two or three. Often this crossing is intermittent to begin with, occurring when a child is tired, or focusing on things up close. Examination usually shows that there is considerable farsightedness, and in that case glasses will often straighten the eyes, or at least reduce the crossing. (Note that the eyes will still cross without the glasses). Children with this type of crossing (which is called accommodative esotropia) very commonly have amblyopia, and need patching of the strong eye to improve the vision of the weak eye.

As long as the eyes are straight with glasses, surgery is not needed, but if the eyes cross despite glasses, then surgery will be needed.

Exotropia - This is an outward drift of one or both eyes. It is most likely to be seen when a child is tired, daydreaming, or looking at things far away. Whereas double vision is uncommon in children with esotropia, it is fairly common in children with exotropia. If a child with exotropia sees double, he will often close or cover one eye to get rid of the double vision. This happens very commonly when going out in bright sunlight. Exotropia typically is intermittent: sometimes you see the outward drift, and sometimes you don’t. Over time the trend is usually for the misalignment to be seen more and more often, and most people with exotropia need surgery to correct it eventually. However, many can go for years or even decades before surgery is needed.

Vertical Eye Misalignment
An eye may float or drift upward either constantly, intermittently (such as when tired), when looking straight ahead, or only when looking to the side. These forms of eye misalignment are not helped with glasses. Patching to make the weak eye stronger may improve control of the misalignment (so that it is manifest less often) but will not eliminate it. If the misalignment is frequent when looking straight ahead, then eye muscle surgery may be needed.






blocked tear drainage | failed screening | headaches | nystagmus |
red bumps | ROP | strabismus |
horizontal eye misalignment | esotropia | exotropia |
vertical eye misalignment
| the red eye | sports related eye injuries


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