Toddler sudden eye problem

Dear Doctors,

My son is 34 months old.  

On Nov. 4, after his nap, we noticed that he tilted his head to look at us when he was called.  With closer examination, we found that his left eyeball cannot move up in the same way as the right eyeball.  We also noticed that his left eye is slightly swollen and has a double eyelid line (normally, his single eyelid)

We had no family history of eye problem.

We never noticed him having any eye problem before Nov. 4.  Even on Nov. 4 morning, he was able to roll both his eyes upward to "scare" me.  We have pictures taken days before Nov. 4, in which he was looking straight at camera with full front view (both eye balanced with no head tilt); while pictures taken after Nov. 4 showing him tilting his head up and turned to right.  

He has allergy, and switched to Singulair & Clarinex in the beginning of Oct.  During the week of Nov. 4, he was also taking a cough medication called Albuterol Sulf 2mg/5 ml sytev due to a cold.  

Few days later, we met with his Ophthalmologist for the first time.  The session was a failure as my son refused to cooperate with the doctor to make any eye movement.  Base on a picture I took on Nov. 5 showing the misalignment of two eyeballs, doctor suspected it's Brown's eye.  However, it is inconclusive and we have another appointment in four weeks.

2- 3 days after he stop taking the cough medicine, his eye problem seem to lessen with less severe head tilt.  However, the head tilt still exists today.  His left eye has no problem move side way and downward, but just cannot move upward as the right eyeball.  

My questions and concerns are:

1.  If it is Brown's eye, is it possible for my son to develop Brown's eye so suddenly?  

2.  Is it possible it's caused by the use of allergic medication?  He had a long history of taking Zyrtec, but Singulair and Clarinex were only introduced about a month before the eye problem.

3.  Could it be any Thyroid related eye problem since it comes up so suddenly?

We are very desperate.  Our Ophthalmologist was not very helpful and when I asked why the problem came up so suddenly, he said I just did not noticed it before.  However, as my son's primary care since his birth, I am quite confident that he had no eye problem before Nov. 4.  I have pictures and videotape that can demonstrate the difference before and after Nov. 4.  I really hope there is no major underlining problem with him.

Thank you for your help.

Shirley

[John C Hagan III, MD, FACS, FAAO]

Brown's Syndrome may develop suddenly or the awareness of it may be sudden. It would not be caused by the medications. Thyroid eye disease is rare in children and would not give this picture.

I would get a second opinion from a Pediatric Ophthalmologist. They do nothing but kids and adult strabismus. Your pediatrician should know of one or you can go to www.aao.org and find one near you. When you go in take your pictures.

Here's more information on Brown's Syndrome:  http://www.revoptom.com/HANDBOOK/March_2004/sec6_3.htm

JCH IIII MD