Who should be evaluated?
Babies and children
Babies and children with strabismus should be checked right away to prevent amblyopia, which results in loss of vision and depth perception in the misaligned eye. Amblyopia can occur even if the eye is only slightly misaligned because a developing child's brain will stop communicating with that eye, shutting it off. This is why amblyopia is sometimes referred to as "lazy eye."
Unfortunately, it isn't always easy for parents to tell if a child's eyes are crossing, particularly in those children with a mild case of strabismus. If your child is showing any of the following signs and symptoms of strabismus, you should call today and schedule an appointment for an eye exam with one of our pediatric ophthalmologists.
Crossing eyes in newborns. Many parents are told that in the first three months of life, it is not unusual for a baby's eyes to wander. This is partly true. It is not unusual for a baby's eyes to occasionally wander outward, but if one or both of a baby's eye turn inward during this time period, especially if the eye is constantly turning in, the baby should have an eye exam. If it wanders outward part of the time, its probably okay to wait, but if it is always turning outward and never straight then the baby should have an eye exam.
Eyes crossing or turning out after 3 months of age. If you notice one or both of your baby's eyes wandering or crossing either in or out after 3 months of age, your baby should have an eye exam.
Head tilting or squinting. If your child is routinely tilting his or her head in an unusual way to see something, that may indicate a vision problem. Children may do this to effectively line the eyes up in a certain way to get the best vision.
Red eye reflection in one eye. An annoyance in family pictures, the "red eye" reflection can sometimes provide valuable information about vision. If "red eye" is showing in only one eye rather than both eyes, it may be a tip-off that your child is having a vision problem and should have an eye exam.
When a sibling has strabismus. If a brother or sister has been diagnosed with strabismus, it is a good idea to have your baby or child examined, even if there are no obvious signs of the problem.
Other than obvious misalignment of the eyes, some of the signs and symptoms of strabismus in adulthood are different than those in children. For more information on strabismus in adulthood, see Adults with Strabismus, Q&A with Dr. Hunter.
How we treat strabismus in children
Each year, our pediatric ophthalmologists see numerous children with strabismus, mild and severe. We recognize that every child's condition is different with its own unique challenges and as a result, strategies to correct one case may be drastically different than the approach in another case.
For instance, when strabismus is mild, your child's eye doctor may prescribe glasses to correct the alignment problem and sometimes the doctor may recommend placing a patch over the normally functioning eye for a number of hours every day. "Patching" can help remind the brain that it needs to pay attention to both eyes, which sometimes can improve the alignment.
In more difficult cases and in cases where glasses do not correct strabismus, eye muscle surgery is typically needed to straighten the eyes and prevent vision loss. The surgery involves detaching the muscle or muscles that is causing misalignment and reattaching it or them to a new spot. The location of reattachment is determined using precise measurements taken of the eye in advance of surgery. Our doctors and their assistants are able to make these measurements even in children who may not be fully cooperative for examination. In many children, this process is straightforward, but in others, where multiple muscles are involved, the problem becomes more complex.
If you come to Boston Children's Hospital, you have access to pediatric ophthalmologists who routinely treat difficult cases. Our eye doctors are actively involved in research that is shaping the way strabismus is detected and treated around the country and the world. These doctors are also training fellows and residents. This often results in a collaborative effort to come up with creative solutions to correct a child's unique problem.
Some of our more innovative approaches for strabismus in children include:
Very few places in the New England region and in the country offer Botox injections as an option for treatment in children with strabismus. At Boston Children's Hospital, eye doctors can sometimes use Botox (Botulinum Toxin A) in lieu of eye muscle surgery to correct strabismus. Sometimes, this method proves effective in children for whom surgery has not corrected the misalignment. For adults and older children, this treatment can be given in the office. For young children, the procedure is performed in the operating room with a brief anesthesia but without need for incisional muscle surgery.
Adjustable sutures in eye muscle surgery
One specialized technique that sometimes used in children with complex strabismus and almost always used in our adult patients involves adjustable sutures. Adjustable sutures allow our ophthalmologists to readjust the position of the eye after surgery. When a patient is asleep during surgery, it is difficult to tell whether the eye has been repositioned precisely as it should. Before adjustable sutures, surgery would have to be rescheduled to reposition the eye if it didn't come out as expected. But now, with adjustable sutures, the position of the eye can be readjusted in the recovery room to avoid the need to reschedule additional surgery.
It may be hard to believe that a child would sit still for the adjustment of adjustable sutures, but our surgical and anesthesia teams perform these adjustments routinely and know how to help a child stay calm and cooperative throughout the process. If a child is too young or too fearful to cooperate for adjustment, the procedure can be completed with a brief secondary anesthetic in the recovery room without needing to return for surgery.
For more information on this service or to schedule an appointment, call 617-355-6401.