Diagnosis of strabismus (crossed-eye) in children under 2 yo?

[Saffron]

How is strabismus diagnosed in children under 2 years old? Is it even possible to make the diagnosis so young? Reading this you're thinking, Surely if the child has a crossed-eye it's obvious.

Hmmm.

MIL insists my daughter (18 months) has 'a turn in her eye'. I don't see it personally. What I do see is that my daughter does go a little cross-eyed on rare occasion. (You would probably go cross-eyed too when people waved things around 10 cm from your face going, Ooo lookie-lookie!) Occasionally going cross-eyed is normal and is not the same as having a crossed eye.

So is it wasting the GP's time to take Little Saff there? Do you need some special equipment to positively id strabismus in a child under 2 yo? I thought they only tested the under 2s for ocular abnormalities if they were high-risk (eg congenital eye problem), and stereoscopic vision isn't assessed at all until 3 / 4 years old?

And, if it turns out that Little Saff does have stabismus, how do they even treat it in a child so young? I'm not keen to spend an afternoon in the drs office just to be told that treatment would only be watchful waiting anyway. At the same time, I'm fed up with comments from the MIL. Grrr.

Anyone have any experience with this?

xxxx

[Belle]

I have a friend whose young daughter had very obvious crossed eyes from birth, she actually had an operation for it at around 1 year, and from what they told me (can't recall all details) she didn't have binocular vision, and that was partly why she needed an operation. As far as I know she has recovered well. I do remember she had glasses before, wonder if that's a treatment for milder instances? Can see though that if it's not a definitive case, might be harder to diagnose/act on it - I'd go to your GP to query in any case, if for no other reason than to have a good retort to your MIL!

[Fuschia]

Child no 1 was referred to someone and checked out for this at <1y

My memory is a bit hazy though

[Saffron]

@ Belle: Yep that's kinda what I was thinking too. And as far as we can all tell, Little Saff's vision is completely fine. It's obvious that she can see what she wants and act on it accordingly. She definitely wouldn't be a candidate for surgery at this point, and I really can't see us being able to keep corrective eyewear on her for more than five minutes unless it was strapped in place with duct tape. ;-)

[srisky]

An eye patch is sometimes used to cover the 'stronger' eye and allow the 'weaker' eye to strengthen. This option is in some ways easier on young children, as they won't be aware that they have a patch and other children don't. Equally, it can be difficult to stop them taking it off! Obviously, whether this is an option will depend upon the nature/severity of the strabismus.

[Claire29]

I was concerned about my son who was just over 2 at the time, that sometimes I noticed one eye went in slightly and also in photos I could see it. The doctor referred me to Kings and I took him there for an appointment. I was a bit concerned how they would be able to check as getting him to sit still for long wasn't easy. But they did a few tests looking at different pictures asking what they were etc and got him to wear some glasses with different lenses to check. It was quite hard as I was 8 1/2 months pregnant at the time but we managed with good old fashioned bribes....a lollypop and some chocolate! I think it's best to get checked out the younger they are, and I know my brother had to wear a patch when he was around 2 for a lazy eye, which was corrected by doing this. Turned out my little un's eyes were ok, I was glad I had taken him to get him checked.

[Saffron]

Hi Claire29- That's very interesting. Was what your child had referred to as pseudostrabismus? I.e., angle of the eyelid or bridge of the nose gives the eyes a inwardly turned appearance, although there is no ocular misalignment whatsoever. Children naturally outgrow this as the shape of the lid/bridge matures.

My daughter wouldn't be anywhere near developmentally able to perform as your LO did obviously, 6 or 7 months makes a lot of difference at this age. I thought perhaps she could be assessed with the Hirschberg test. I think this is basically a photographic test looking at the angle of corneal reflection. I think it doesn't involve anything other than looking at a light long enough for a photosnap?

I'm going to phone the GP tomorrow just to put the whole issue to rest.

[EDmummy]

It is not uncommon for children the age of your child to be referred to an orthoptist (they should send you to ophthalmologist first to check eye health). Both of mine were checked very early on. One has an intermittent squint which is checked every 6 months to see if it worsens, the other has an eye muscle problem called exophoria. The exophoria was not picked up for a number of years (it is not obvious when looking at him) and unfortunately his early schooling was affected. All fine now after exercises to teach him how to stop his eyes flicking out.

If your child has an intermittent squint then they may just watch it to see if treatment is needed. I would definitely say getting this checked earlier rather than later is the right approach.

Good luck

[edanna]

We saw a Kings orthoptist at Townley Rd clinic, referred by HV at 8 month check. She was great. I don't know how they do it but they can check even under-1s. It's def worth getting a referral, either just for reassurance or to have them in the system. Both of my kids' vision is fine but they are being reviewed in 6 months because of family history of short sight etc.

[Saffron]

Stopped by the GPs office today and was surprised and pleased that we can be seen by the doctor on Monday morning (usu a 2 wk wait). I must admit to being quite curious about the outcome.

[Saffron]

So, we were seen by the GP yesterday. She had my daughter follow her finger and a toy with both eyes, then a sort of peak-a-boo game with one eye covered, then other covered. This was in between fits of wild laughter from Little Saff who could not keep still to save her life. I don't know how anyone could even keep an eye on her, let alone keep an eye on her eyes. Nevertheless, the GP seemed quite confident that there is no occular misalignment. She did not even refer us for a photographic Hirschberg test. So now I can tell my MIL to stop worrying.

[Otta]

Not wasting anyone time Saffron. Can probably be solved with eye patches used to make muscles work harder.

If you're at all concerned, ask for a referral to Kings.

[Saffron]

Nope, i'm not at all concerned. I never thought she had a crossed eye at all! I have always said it's due to the angle of her eyelids and the width of her bridge, both of which will change as she grows. It was my mother-in-law (who only sees Little Saff a couple times a year anyway) who was worried. I'll be very pleased to tell her all is well!!

[The Nappy Lady]

Saffron,

Glad all is well.

I am told that I have a slight tendency to squint in 1 eye only when overtired.

My optician picked up on it a couple of years ago. I remember at school at one of the eye tears I was referred to hospital because of it and then on the day they couldn't find any problem & it was only picked up again 30 or years later!

What the doctor said sounds good, but keep an eye on little Saff just incase as it may be somethjng that comes & goes. Though hopefully not of course!

[jmac]

I would not take my GP's word on something like this - take your daughter to a good optician and have her checked. They are the experts on the eye and I don't believe GP's have adequate training. My brother is an ophthalmologist and whenever I have gone with any of my three, he always tells me that the earlier squints are 'caught', the easier they are to fix...