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Eye Care Archive (Expert Forum)
Preschooler with irregular eye movement
Our Ask A Doctor Ophthalmology Forum is where you can post your question and receive a personal answer from physicians affiliated with the American Academy of Ophthalmology.
Preschooler with irregular eye movement
by Boomerpop, Oct 13, 2006 12:00AM
My son (3yrs) frequently has one eye that moves independently of the other. He rubs his eye or opens his mouth to make the eye move back into proper alignment. He says his eye "goes in" and he stretches his mouth/face to make it "go back out". He has also said his "eyes go this way and that way at the same time". I believe that when this happens, he may have double vision and/or some dizziness. He has also complained of sensitivity to light and squints one eye. Usually, his right eye is affected most, but his left eye is also affected.
This happens at least once per hour throughout the day, began in July 06, occurs all times of day, with close-up activity as well as looking across the yard. It seems to occur more often when he is congested. He has mentioned "buzzing" in his ears.
He had eartubes because of effusion and hearing loss in Jan. 06.
An optomologist visit in July 06 found no evidence of strabismus and said vision was good in both eyes with some nearsightedness typical of his age.
A family practice doctor found indication of viral illness with a blood test, but while the typical viral symptoms went away, the vision problems continued. On a return visit, he referred us to a pediatrician thinking he may be having migraine episodes. He doesn't complain of headaches. He has mentioned that he knows when his eye will turn because it hurts right before it happens. However, he hasn't been consistent in complaining of eye pain.
We'll be seeing the pediatrician next week. I would appreciate any insight you could offer. Thank you!
This happens at least once per hour throughout the day, began in July 06, occurs all times of day, with close-up activity as well as looking across the yard. It seems to occur more often when he is congested. He has mentioned "buzzing" in his ears.
He had eartubes because of effusion and hearing loss in Jan. 06.
An optomologist visit in July 06 found no evidence of strabismus and said vision was good in both eyes with some nearsightedness typical of his age.
A family practice doctor found indication of viral illness with a blood test, but while the typical viral symptoms went away, the vision problems continued. On a return visit, he referred us to a pediatrician thinking he may be having migraine episodes. He doesn't complain of headaches. He has mentioned that he knows when his eye will turn because it hurts right before it happens. However, he hasn't been consistent in complaining of eye pain.
We'll be seeing the pediatrician next week. I would appreciate any insight you could offer. Thank you!
Doctor's Answer
by Forum-OD-MP, Oct 13, 2006 12:00AM
not having seen your son, i cant/wont make any diagnosis of any kind. but i can tell you a few things based on probabilities and my experiences (i have a mostly-pediatric practice)
1) it is unlikely IMO that his "eye turn" is from any virus or migraine, or ear tubes. further visits to pediatricians are probably not going to yeild much (if any) new information
2) this SOUNDS TO ME like "accommodative esotropia"..or FARSIGHTEDNESS causing one or both eyes to periodically turn in.
#2 makes a lot of sense in this case:
a) started at age 3...the typical age at which accomodative esotropia presents
b) an ophthalmologist found "no evidence of strabismus"...i cannot tell you how many discussions/arguments i have had with ophthalmologists (especially "general" ophthalmologists) over this subject, some of them heated. if the eye turn doesnt present itself during the exam, and/or if they dont think its "bad enough" to be a surgical case, they'll just announce that he doesnt have "strabismus". which is perfectly obvious b/c the definition of "strabismus" is a CONSTANT (like 100% of the time) eye turn. it makes them sound smart to make a diagnosis of "no strabismus", when in reality nearly any layperson could make that call. he either has an eye turn 100% of the time (strabismus) or he doesnt (not strabismus).
c) the ophthalmologist announced that he was "nearsighted". this is A HUGE red flag to me. almost no "nearsighted" patient without strabismus (remember...CONSTANT eye turn) has an "occasional" eye turn. that would be a "zebra" big time. "internuclear ophthalmoplegia" or some other rare cranial nerve problem/condition. an ophthalmologist would probably not miss that (i would hope not).
if i were a betting man (which i am not)...just based on the information you have presented so far i would probably have to lay big bucks on the "he's not nearsighted...he's FARSIGHTED and has "accommodative esotropia"". you need a second opinion. preferably with an optometrist who sees a lot of pediatrics, or the next best option IMO would be a pediatric ophthalmologist. and he needs a CYCLOPLEGIC refraction/retinoscopy, not merely a "dilation".
the nearest pediatric ophthalmologist to me is 200 miles away. he & i freqently argue. i have quit referring any patients to him b/c i totally disagree with him on a lot of big issues, but i still end up having to argue with him & his staff occasionally b/c patients of his come to me for 2nd opinions and vise versa.
w/o getting too much into this, i'll give you a little insight so you know what you might be up against.
ophthalmologists are surgeons. they like surgery and want to perform surgery. here's what i see ALL THE TIME. like 3x/year:
some 2-3 year old has the problems you describe with your son. an eye turns "in" occasionally. the ophthalmologists that i know either deem him "fine" or suggest that he has "strabismus" and advocate surgery. not to beat this into your head, but rememeber that "strabismus" is a CONSTANT eye turn. occasionally having an eye turn in is NOT strabismus. but many surgeons will go ahead and do surgery on a significantly farsighted child with an eye that is turned in, in order to turn the eye back out. but guess what? they're still farsighted. this causes major problems for some patients...some of them immediately. but ESPECIALLY when they get in their mid to late 30's. then they sometimes are really screwed. double vision that cannot be fixed with lasik or glasses or contacts...must have STRAB surgery again at age 38 or whatever. nice.
anyway, i've already made this way too long and probably offended some ophthalmologist readers. but IMO you need a second opinion from a pediatric optometrist or pediatric ophthalmologist. and again i'd be willing to be your son is NOT "nearsighted"...barring a "zebra" diagnosis, he's almost got to be farsighted and accommodative esotropia.
good luck
1) it is unlikely IMO that his "eye turn" is from any virus or migraine, or ear tubes. further visits to pediatricians are probably not going to yeild much (if any) new information
2) this SOUNDS TO ME like "accommodative esotropia"..or FARSIGHTEDNESS causing one or both eyes to periodically turn in.
#2 makes a lot of sense in this case:
a) started at age 3...the typical age at which accomodative esotropia presents
b) an ophthalmologist found "no evidence of strabismus"...i cannot tell you how many discussions/arguments i have had with ophthalmologists (especially "general" ophthalmologists) over this subject, some of them heated. if the eye turn doesnt present itself during the exam, and/or if they dont think its "bad enough" to be a surgical case, they'll just announce that he doesnt have "strabismus". which is perfectly obvious b/c the definition of "strabismus" is a CONSTANT (like 100% of the time) eye turn. it makes them sound smart to make a diagnosis of "no strabismus", when in reality nearly any layperson could make that call. he either has an eye turn 100% of the time (strabismus) or he doesnt (not strabismus).
c) the ophthalmologist announced that he was "nearsighted". this is A HUGE red flag to me. almost no "nearsighted" patient without strabismus (remember...CONSTANT eye turn) has an "occasional" eye turn. that would be a "zebra" big time. "internuclear ophthalmoplegia" or some other rare cranial nerve problem/condition. an ophthalmologist would probably not miss that (i would hope not).
if i were a betting man (which i am not)...just based on the information you have presented so far i would probably have to lay big bucks on the "he's not nearsighted...he's FARSIGHTED and has "accommodative esotropia"". you need a second opinion. preferably with an optometrist who sees a lot of pediatrics, or the next best option IMO would be a pediatric ophthalmologist. and he needs a CYCLOPLEGIC refraction/retinoscopy, not merely a "dilation".
the nearest pediatric ophthalmologist to me is 200 miles away. he & i freqently argue. i have quit referring any patients to him b/c i totally disagree with him on a lot of big issues, but i still end up having to argue with him & his staff occasionally b/c patients of his come to me for 2nd opinions and vise versa.
w/o getting too much into this, i'll give you a little insight so you know what you might be up against.
ophthalmologists are surgeons. they like surgery and want to perform surgery. here's what i see ALL THE TIME. like 3x/year:
some 2-3 year old has the problems you describe with your son. an eye turns "in" occasionally. the ophthalmologists that i know either deem him "fine" or suggest that he has "strabismus" and advocate surgery. not to beat this into your head, but rememeber that "strabismus" is a CONSTANT eye turn. occasionally having an eye turn in is NOT strabismus. but many surgeons will go ahead and do surgery on a significantly farsighted child with an eye that is turned in, in order to turn the eye back out. but guess what? they're still farsighted. this causes major problems for some patients...some of them immediately. but ESPECIALLY when they get in their mid to late 30's. then they sometimes are really screwed. double vision that cannot be fixed with lasik or glasses or contacts...must have STRAB surgery again at age 38 or whatever. nice.
anyway, i've already made this way too long and probably offended some ophthalmologist readers. but IMO you need a second opinion from a pediatric optometrist or pediatric ophthalmologist. and again i'd be willing to be your son is NOT "nearsighted"...barring a "zebra" diagnosis, he's almost got to be farsighted and accommodative esotropia.
good luck
Member Comments
by Boomerpop, Oct 15, 2006 12:00AM
Thanks for your quick and thorough reply. We will be seeing an opthalmologist soon.
