infant with crossed and bulged eyes

[crescentstreet]

hello, my son is 2 1/2 years old.  about a week ago, he crossed eyes intensely for about an hour to look at a mobile toy in his play gym.  since then, his eyes have turned in and have bulged out slightly -- or rather have this "deer in the headlight" look constantly.  what happened?  i took him to a pediatric ophthalmologist and confirmed that he doesn't have strabismus.  did he have ciliary muscle spasm and is it what's causing his intense look?  if he has accommodative spasm, will he develop -- or does he already have -- myopia?  what can i do to reverse his constant intense look of his eys back to his soft, sweet gaze?  thanks so much.

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

The eyes and facial appearance could change as a result of problems in the orbit or the facial bones. That's why you need to see the pediatrician also. The ciliary muscle is the only focusing muscle of the eye. There are 6 muscles on each eye that move it in different directions. Many children appear to have crossed eyes but don't. This is called pseudo-strabismus and is usually due to a curved tissue from the inner upper to the lower lid (epi-canthal fold).  I think accommodative spasm is not the problem but it would be treated not with myopic glasses but dilating drops to relax the ciliary muscle. I hope that the next visit to a second pediatric ophthalmolgoist will be reassuring. Please post what he/she says.

JCH III MD

[crescentstreet]

thank you again.  we have an appt. with another pediatric ophthalmologist next friday.  in general what kinds of things would cause the change in appearance of eyes? i'm concerned not so much about the crossed eyes but that intense bulged-out look he has.  he no longer has soft gazes, only this one startled look ALL the time.  if he's not smiling, his eyes make him look mad or serious.  this is not my baby -- this i know as his mother.  he was taking much interest in the world around him before this incident without looking so angry.  is it the focusing muscle that's strained -- what are other focusing muscles besides ciliary muscle?   is it possible that his eyes have moved closer to the center without having turned, thereby giving the appearance of crossed eyes without strabismus?  also, in the rare chance that he did have ciliary spasm, he will have developed psuedo myopia, no?  is convex glasses the remedy?  is that why he only wants to focus on near objects? would you recommend using atropine to relax his muscles?  your reply will help me ask informed questions to the pediatric ophthalmologist at our appointment.  thanks for your time.    

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

In a normal infant without strabismus and/or high hyperopia (farsightedness) crossing the eyes to look at near objects will not cause them to get "stuck" there or induce strabismus. It really sounds like a visit to the pediatrician or a call back to the pediatric ophthalmologist would be worth the time and expense to put your mind at ease.

JCH III MD

[crescentstreet]

thank you for your reply.  is it possible that very strainuous eye crossing for a prolonged period time at his age (2 1/2 months old) could change the appearance of his eyes?  say, for example, if the shape of his cornea changed, or if there is more pressure in the anterior chamber of his eyes, would that change the appearance of his eyes?  he never looks relaxed.  he has this intense look constantly and he also wants to only focus on close objects.   thanks so much.

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

The examination by the pediatric ophthalmologist would have included a determination that your child is not significantly near-, far- sighted or have astigmatism. Also you indicated that he does not have strabismus.  Accommodation spasm isn't all that common especially in an infant and is unlikely. Be sure to have him seen by your pediatrician to discuss your concerns and for a complete physician exam with special attention to the neurological system.

If both of these exams are normal then on-going observation is indicated. Kids change very quickly at his age and it could be that you are just noticing him become more aware of his surroundings and taking an interest in what he's seeing.

JCH III MD   Eye MD  = Ophthalmologist

[crescentstreet]

sorry, one correction -- my son is 2 1/2 months old not 2 1/2 years old.  thanks!