The medical word for an eye misalignment is strabismus and this condition affects approximately two to four percent of children. There are different kinds of strabismus which are typically noticed when one eye appears to be crossing inwards or drifting outwards. An eye can sometimes move upwards as well. In some cases, the strabismus is constant and the eyes are never properly aligned at all. Strabismus can also be intermittent, with the eyes sometimes looking straight and looking misaligned at other times. It is important to examine every child with an eye misalignment as early as possible in order to prevent vision loss from amblyopia.
Eye Crossing (Esotropia)
Esotropia happens when one or both eyes are crossing inward. It can be constant or intermittent. Esotropia can be caused by a congenital problem (Congenital Esotropia), focusing problem (Accommodative Esotropia), poor vision in one eye (Sensory Esotropia), or rare conditions including the nerves and muscles that move the eyes.
Because low vision and focusing problems can be causes of esotropia, it is very important for the child to have a full eye exam to make sure the vision is equal and working in both eyes. The exam requires dilating drops in order to figure out if the esotropia can be corrected with glasses. Esotropia may be treated with regular glasses, glasses with a bifocal, patching, or in some cases, with surgery.
Eye Drifting (Exotropia)
Exotropia happens when one or both eyes are drifting outward. This kind of strabismus can be constant or intermittent. In some cases, exotropia can be caused by a congenital problem (Congenital Exotropia), but most of the time, exotropia is intermittent. A common symptom in intermittent exotropia is eye drifting when the child is tired and closing one eye in bright sunlight to avoid the way it feels to have the eye drift out. Exotropia may also be caused by poor vision in one eye (Sensory Exotropia).
It is important for every child with exotropia to have a complete eye examination to make sure both eyes are working well and are healthy. We use eye drops in every exam to check and see if the child needs glasses or if glasses may help them use their eyes together. Treatment of exotropia usually involves helping the brain to use the two eyes together so that the eye does not drift out. Treatments may include glasses, patching, vision therapy for patients who have difficulty converging, or correction with surgery.
Some children will put their head in a certain position in order to make their vision better. They may do this when they are trying to read small letters in a book or when they are watching a really interesting movie because their new face position may improve their vision. In some cases, they can change their head position because their vision is blurry and they need glasses. Other times, they may have strabismus and need to keep their head in a particular position in order to keep their eyes straight and working together. If a child tilts their head to the side, the muscles in their neck may tighten and it can be uncomfortable. In these cases, we recommend a complete eye examination to see if there is any underlying strabismus or need for glasses.
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