Dr. Bob: My three-month-old daughter appears to have crossed eyes at times. Some family members say don’t worry about it, that it will go away. Some family members have warned me about potential dangers. What is the best course of action?
Answer: You are right to be concerned about your infant’s eyes. They are critical to vision and your attention to them and your doctor’s exams will be so important in the days ahead. Let’s address some of the early common vision concerns in addition to crossed eyes.
- Possible neonatal infection. Placing an antibiotic ointment or drops in the eyes to prevent a serious infection that could lead to scarring or blindness is done on every baby in the first hour of life. The minimal irritation that resolves from the eye medicine far outweighs the risk of a serious infection. This is a state law in South Carolina and in place for good reason.
- Your pediatrician will be examining the eyes at your infant’s checkups. You might wonder what they can see. They can see the red reflex in addition to eye movements and apparent processing of visual images. You know the red reflex from old pictures where the flash caused the eyes to have a red dot. The light from the ophthalmoscope goes in and reflects back from the back of the eye. An intact eye apparatus should have a normal red reflex. An impaired red reflex might occur because of a problem in the cornea or in the lens or in the retina. Congenital glaucoma, an increased pressure of the fluid in the eye, is a serious condition and might be detected from some change in the cornea or in the shape of the eye altering the red reflex. Rare eye tumors can be detected from an abnormal red reflex.
- I have had many parents tell me that they are concerned about possible eye crossing like you mentioned. In the first several months of life, the eyes will sometimes cross. Normally, this intermittent crossing will go away, but close attention is needed to make sure that it does. Persistent crossing is known as strabismus. If strabismus is persistent, prompt attention and examination by an ophthalmologist is needed. Untreated strabismus can lead to long term visual impairment. In my experience, the pediatric eye doctors will sometimes do watchful waiting, eye patching, eyeglasses or even surgery. Six muscles control the movement of each eye, and surgery may be needed to correct an imbalance. One other thing about eye crossing. Sometimes you will think that the eyes are crossed but it just looks that way because of prominent skin folds near the corner of the eye. This is called pseudo-strabismus and not a concern.
- If you have any concerns about your child’s visual attentiveness, be sure to bring it to the attention of your pediatrician. They will probably recommend referral to the pediatric eye doctor. You might ask yourself, “How can the eye doctor really tell about the eyes? My child is too young for an eye chart.” Well, pediatric ophthalmologists are very skilled at examining the eye and can make significant judgments about vision and near-sightedness and far-sightedness. By dilating the pupil and using various lens, they can assess vision and make timely and potentially life-changing interventions.
To get back to your specific question. Please attend all of the indicated check-ups and let your pediatrician know your concerns about the eyes. Timely interventions are crucial to maximize your infant’s sight.
Dr. Saul is Professor of Pediatrics (Emeritus) at Prisma Health and his website is www.mychildrenschildren.com. Contact Dr. Bob at askdrbobsaul@gmail.com with more questions.