Early Detection and Treatment is Key for Cross Eyes

LA Parent: Health-e Blog, by Christina Elston, March 3rd, 2009 (click here for website)

Editor’s note: As a little girl, I wore glasses but didn’t really understand why. My mom said it was because one of my eyes “turned in,” and it wasn’t until many years later that I learned the word “strabismus.” Fortunately, my condition was diagnosed fairly early and corrective lenses straightened out my gaze and saved my vision. Here’s an article by Dr. Angela N. Buffenn, director of the Orbit and Eye Movement Institute at Children's Hospital Los Angeles’ Vision Center. She’s also assistant professor of clinical ophthalmology at the USC Keck School of Medicine.

Every day when coming home from work, Marisa Baigorrotegui was greeted by her 2-year-old daughter, Nicole, who loved to wave to her mom through the window. As Baigorrotegui watched her daughter’s eager smile, she began noticing that the toddler’s eyes were not focusing on her. “Even though she was looking right at me, her left eye was turning inward,” Baigorrotegui, of Torrance, explained.

She immediately made an appointment with her daughter’s pediatrician, who referred them to a local ophthalmologist. Nicole was diagnosed with strabismus, commonly known as cross eyes, and was prescribed corrective glasses. But by the time Nicole was 4, her right eye was beginning to turn inward as well. That’s when Nicole’s parents brought her to The Vision Center at Children's Hospital Los Angeles, home to perhaps the largest pediatric ophthalmology program in the United States, where my colleagues and I treat many complex forms of eye disease, including eye cancer and corneal and retinal disorders.

I have been conducting extensive research on the surgical and medical management of strabismus, a vision condition causing misalignment of eyes. For children like Nicole who have this condition, the eyes may turn in, out, up or down. The misalignment of the eyes may be constant or intermittent. While the causes of strabismus are still unclear, we are certain that early detection and intervention are key to correcting the misalignment of the eyes and preventing possible vision loss.

Get a Newborn Vision Exam

When children have cross eyes, the brain receives an image that falls on different areas of the retina in each eye. Since these areas do not match, it’s impossible for the brain to use both images together normally. Often, the brain learns to ignore the image coming from the misaligned eye in an effort to “fix” the problem, which can lead to loss of vision in that eye. With early diagnosis, the defect can usually be corrected either with glasses or surgery. Patching may also be needed if decreased sight is present.

In a number of cases, the misalignment shows itself shortly after birth. This is why pediatricians should conduct a thorough vision exam on newborns and parents must be sure to have their child examined if the baby’s eye alignment seems abnormal. One very important milestone age is at four months of age. If you notice that your baby’s eyes are misaligned and have not corrected themselves by four months of age, take your child to a pediatric ophthalmologist. I have had many cases where my patients were told to wait because the baby will outgrow this, but by the time they come to me, it may be too late to save the child’s vision.

Seek Treatment Early

Between the ages of 7 and 10 is another important milestone. This is the age our brains basically set our vision in stone. Prior to age 5, the brain has the elasticity to adjust vision in response to treatment. After age 5 and even greater after age 7, the sight is less likely to improve.

Fortunately for Nicole, who is now 7 years old, her parents were quick to notice and respond to her condition. She underwent corrective surgery on both eyes at age 5. She continues to wear glasses, but the misalignment of her eyes are substantially decreased and the first-grader is busy enjoying a full spectrum of activities, including making bead bracelets and sock puppets, hula dancing and soccer.

Strabismus surgery repositions the eye muscle, ultimately strengthening or weakening it to change the alignment of the eyes. It is an outpatient procedure and patients must administer antibiotic drops for about a week following surgery. Another form of treatment that is often used either in combination with glasses or surgery, or by itself, is patching. The child wears a patch on the “good” eye for a certain amount of time each day to force the weaker eye to work harder. The amount of time a child wears a patch varies substantially, from two to eight hours a day, for several months to several years.

Many children resist wearing the patch. It can be a very emotional situation. Sometimes, the children cry because they don’t want to wear this patch. But I always tell the parents to think long-term. If we wait until the child is older and can understand the consequences, it’s often too late to fix the problem resulting in permanently decreased sight.

For more information on strabismus, click here.