The goal of pediatric eye care is the early recognition and treatment of a problem. The earlier a child's eyes are aligned (straight) and good equal vision is established the better the prognosis for the development of good vision and depth perception.

It is normal for newborn infants to have some variability of the alignment of their eyes. However, it is not normal for that misalignment to be constant or last longer than three months of age. If a child's eyes are misaligned longer than three months of age, the child needs to have a complete dilated exam by a pediatric eye specialist as soon as possible.

If a child's eyes are constantly or frequently misaligned, the child may have strabismus. Strabismus is a misalignment caused by an extra ocular muscle imbalance. The deviation is present even when both eyes are covered.

A child with crossed eyes (turning inward toward the nose) has esotropia. This is present in both eyes uncovered. A child with an eye that drifts outward (away from the nose) has exotropia. If the deviated eye drifts upward, the child has hypertropia.

A child with strabismus is at a greater risk to develop amblyopia. If left untreated, the eye with amblyopia could develop permanent vision loss or blindness.

At the present time, the best treatment for amblyopia is occlusion therapy-patching the better-seeing eye which forces the poorer-seeing eye to work. This treatment must be carefully monitored by a pediatric eye care professional. Excessive, unmonitored occlusion or patching of the better-seeing eye could lead to vision loss in that eye. However, patching is a safe and effective treatment of amblyopia if done under the care and supervision of a pediatric eye care professional.

Esotropia is a misalignment of the eyes associated with crossing inward of one or both eyes. If the onset of crossing is prior to or at five months, it may be infantile or congenital crossing. This is generally an extra ocular muscle problem and surgery may be required to correct the crossing. Amblyopia, if present, must be treated prior to surgery to correct the esotropia. Infantile or congenital esotropia is usually associated with a large angle of crossing, a small amount of refractive error (no need for glasses), amblyopia and nystagmus (involuntary rhythmic side-to-side or up and down eye movements).

In order for a child diagnosed with strabismus to develop good equal vision in both eyes, he/she needs to be treated by a pediatric eye care specialist prior to age 10.

Early Diagnosis

Most commonly, unequal vision will be detected at a routine pediatrician visit or a preschool screening.

If one sibling or family member has amblyopia in one eye, there is a good possibility that other siblings may also have it.

Parents can play games with their children to help judge if there is decreased vision in one eye.

  • One-eye peek-a-boo: Instead of covering both eyes while playing peek-a-boo, cover one eye. Watch the child's reaction. Does he/she strongly object to the covering of one eye as compared to the other eye?
  • I Spy: Cover one eye (parent and child) and pick out a small target at a far distance. Can the child see the target? Can the child tell details about the target with one eye covered? Now cover the other eye. Can that eye see the details of the target?
  • Cheerios: Hold a Cheerio on the palm of one hand. Cover the child's eye. Can the child see to pick up the Cheerio?

Any concerns regarding the sight of either eye should be reported immediately to the child's pediatrician or pediatric eye care specialist.

Andersen Eye Associates has a pediatric ophthalmologist on staff. Please contact us for more information or to schedule an appointment.


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