drifting eye along with different sized pupils

My 9 month old has pupils of different sizes.  I noticed this at 2 months old and the doctor told me that sometimes this was a normal thing...so I didnt worry.  Now, I have started noticing one eye drifting inward.  It doesnt happen all the time but it is noticeable.  The doctor referred us to a specialist but we cant get in until September.  Could this be something serious or am I just being a worrywart of a mother?  I will appreciate any and all information and treatment options.

[Houman Vosoghi, MD]

It could be serious and you should insist on getting seen sooner than September.  Whether it's simply "crossed eyes" starting or something more serious going on, it should be treated as soon as possible in a nine month old as no degree of crossing is normal at that age.  Rarely, this could be caused by central nervous system abnormalities and depending on how big the difference in pupil size is and whether it is worse in the dark or light, your child could need an MRI.  Does your child have a droopy eyelid on the side with the smaller pupil?  Are there any other abnormalities that you are noting.  You should read up on the causes of anisocoria (different sized pupils) and Esotropia (crossed eyes) and call the pediatrician saying how concerned you are etc to get help getting in sooner.  Again, no degree of crossing of the eyes is normal at nine months of age and waiting three months to get evaluated by a pediatric ophthalmologist is unacceptable.  Let me know how it goes please.  If you have trouble, you may have to take him/her to a pediatric ER where there is a pediatric ophthalmologist covering to get "hooked in" to the system and get an earlier referral (extreme case scenario).


HV