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Lazy eye, squints, glasses etc.....

(910 Posts)
cheekyginger Thu 01-Sep-11 22:38:05

Im an orthoptist (binocular vision specialist) and a mummy.

I thought i would start this thread in case anyone was wanting any advice, re-assurance, opinions about any eye problems that you wee ones are having.

Peterpanandaliceinwonderland Fri 04-Jan-13 21:34:35

sorry it posted before i was ready !! so obvious but so sudden. We took her to Gp and got appt at eyeclinic the next day. She was assessed by a nurse ? who did a test with pics to tell long/short sight, used a pen moving around, a torch and a strip of lenses etc. She said dd was v.long sighted and the squint was to compensate she said muscles were fine. She wanted to get sight test done there and then but no one was availible. She then applied drops and we went to see a doctor ? who then checked the health of her eyes using a thing on his head with a light. He then said we needed to go to the squint clinic in 4 weeks. The reception then said we may need to wait longer as there are no clincs (?) I'm concerned that if we have to wait too long to get glasses her sight may deteriorate further and lead to patching etc which may be otherwise avoided. Is that likely ? It happened so rapidly i'm afraid it will deteriorate rapidly ? What would you expect to happen next squint clinic or eye test ? Is it at the same time ? What comes first the chicken or the egg ?!? Any advice gratefully received. Thank-you

cheekyginger Mon 07-Jan-13 22:17:27

Hi shelvis,

Sorry for the delay in replying. That's me back into normal functioning mode after the holidays!
Try not to feel bad. There are generally no signs that a child needs glasses so it's not your fault. You can help your genes im afraid.

As for glasses. Looks like you have had some helpful advice from other mums. The general tip is to shop around. The thicker "trendy" plastic frames are good for thicker lenses. (My DH is an optician and he's sitting next to me and he agrees!)

His prescription may change as he grows but there is no way for me to tell if his prescription will go down or up. This is very unique to each patient. Laser surgery might have improved by the time your DS is old enough to consider it. Contact lenses are also a possibility when he is a teenager smile

cheekyginger Mon 07-Jan-13 22:28:21

Hi dfghj

It sounds a bit odd that you are now seeing a squint....

Sounds like she might she may have a convergence excess esotropia. Which just means that her eye overconverges when she accommodates (focuses) on something. If it is this type of squint then it can be treated with bifocals to aid the control at near. Then possibly surgery in the future.

If you are going for a 2nd opinion write down convergence excess esotropia and ask them if this a possibility. This should really be assessed by an orthoptist as the Ophthalmologist and Optician are not actually trained to actually carry out the test to diagnose it.

Be re-assured that her eyes are healthy.

cheekyginger Mon 07-Jan-13 22:41:26

Hi Peterpanandaliceinwonderland,

Wow that was quite a post!

Seems like you really werent given much information! The person you seen was more likely to have been an orthoptist. They would have check the vision and also carried out tests to look for the squint and decide what type it was. They would also check the movement of the eyes. The "strip of lenses" was probably a prism bar which allows the orthoptist to measure the size of the squint.

How long is it till your next appointment?

If its longer than 4 weeks i would recommend that you take her to an optician. Some opticians may not be happy to test her if they know you are waiting for a hospital appointment but you'll find one that is willing. But if she has a sudden onset squint then the sooner she is in glasses the better IMO. Even if you get glasses from an optician, keep any further appointments you have at your eye clinic.

In our clinic. If we see a new patient that is squinting we would arrange a glasses assessment on the day or within 2 weeks. The glasses assessment involves getting drops in her eyes. The drops dilate the pupils and allow the optometrist/ophthalmologist to get an accurate assessment of the prescription.

Let me know if you want more info smile

Chislemum Tue 08-Jan-13 13:35:59

dear cheekyginger - thanks very much for this wonderful thread.

my little boy (23 weeks tomorrow) appears to have a squint in his left eye. i can't see it, nor anyone in my family, nor can i see it on any of the photos i have taken of him - and i have studied them for ages now - however HV told me so.

what little one does do is rub his eyes a lot and sometimes one eye is a little smaller for a bit, sometimes the left and sometimes the right, but it is after his wild rubbing which he seems to love at the moment and his eyes always align - at least that is what i see and what my mother sees.

i had a squint when i was five and it was corrected by special glasses (my mother spotted it; she is a trained nurse and always alert to medical issues). i am originally from germany and it is normal to have a yearly eye checkup with a specialist doctor from an early age and i am a little confused with the system here.

HV insisted ds has a squint and referred me to a specialist clinic: what will they do to ds? will he have to have the stingy eyedrops (i remember them from when i was 5 and they were horrible)?

little one had a bit of a flathead issue going on and the osteopath said it was due to his position in the womb, a muscle in his left shoulder needed to loosen, which is now fine. i just thought i add this.

i am just very worried now....

housesalehelp Tue 08-Jan-13 21:11:13

Hi - my DS has convergence excess esotropia - he is nearly 3 and just got his bifocals -all going fine- what's the likihood he will have to have surgery? And when do they normally do it?

Shelvis Tue 08-Jan-13 21:13:52

Thanks for your reply cheekyginger. Guess I've got to play a bit of a waiting game now, in terms of medical science, and trendy designs. Still feel a bit down about it all but trying no to dwell on it. Just one more question. We have been referred to the hospital, which I expected. At my sons age, because we haven't noticed a squint so far, is there now a smaller chance that one could develop? I'm hoping that because one hasn't appeared so far and we are about to get glasses, that we will have managed to prevent a squint?

cheekyginger Tue 08-Jan-13 21:28:59

Hi Chislemum,

Try not to worry. If the HV is convinced then it will be worth getting your DS checked.
The eyes are not really properly co-ordinated until kiddies are about 6-8 months old, so you may see the eyes wander at times. If you had eye problems then it will be worth getting him looked at.

As for what will happen at the appointment...that will depend on who you see. If you see an Orthoptist: he/she will have a look at how the eyes work together and try and get a very rough estimate of what your LO is seeing.
If it's an Ophthalmologist then your LO will have the drops in his eyes. But dont worry too much about this. Little babies are much more tolerant of the drops.

But in the meantime dont panic. The fact that you and your mum have not had any concerns then it is likely to be nothing! But worth getting it checked to put your mind at ease. smile

Pandasandmonkeys Wed 09-Jan-13 04:12:25

Hi. DS is 11 weeks old and since birth his left eyelid has been constantly swollen and the eye appears half open. We asked all the drs and midwives about it, a swab was taken to check for infection and was all clear. I've asked the HV more recently and no one seems concerned except me! Will this problem correct itself over time? Or does it warrant some further investigation? His eyes are also constantly watery and/or full of sleepy gunk, but the whites of his eyes are normal, his eyelids often look very pink and abit inflamed. Thanks in advance.

Chislemum Wed 09-Jan-13 08:22:57

Thank you, Cheekyginger. Thank you very much - wish I could have DS checked by you/or someone as nice and helpful as you.

clarkykitten Wed 09-Jan-13 08:44:21

Hi cheekyginger and thank you so much for starting this thread. My DS (5 years old) has has glasses since he was 18m for an alternating squint, he never needed patching. About 2 years ago they gave him bifocals - I thought this was because he must have difficulty seeing both near and far but the most recent orthopedist we saw said that this was not the case. She also said that they do not like to keep children in bifocals for long so she is hoping the ophthalmologist will give her the ok to reduce the bifocal element when we next see him (no date as yet).

I am a little bit confused as to what the bifocals are for, in that case? DS's squint tends to go in and occasionally up at the same time, so I am aware that there is more than one muscle involved. His eye sight is excellent when he wears his glasses, but there is no difference to his squint when he removes his glasses, as it is just as pronounced as ever. Am I right in thinking that he is likely to have surgery, but the advice is to wait as long as possible to ensure his eye sight is as mature as possible? And he is likely to still need glasses even after surgery? With many thanks smile

cheekyginger Wed 09-Jan-13 21:39:41

Hi housesalehelp,

You must have posted your msg when i was replying to chislemum...

With management of conv ex eso's it depends on how he takes to the bifocals(BF). The idea behind the BFs is to allow the gls to do the accommodating for him and therefore allow his eyes to stay straight at near. The max BF we can give is a +3.00 and the aim is to reduce this over time by +0.50 at a time. This can take a while, even up to 1 year or up to 2 in some cases. If the BF doesnt have the decired effect then surgery will likely be carried out sooner rather than later to try and preserve the binocular vision.

The BF will help build up the binoc vision and allow surgery to be postponed to an age that the orthoptist can achieve much more accurate measurements for the Dr to base there surgery on.

The key to the BF is to have good fitting glasses smile

Hi shelvis,

That would be the hope. If there is no squint and he is into his glasses then fingers crossed he will not develop a squint.

cheekyginger Wed 09-Jan-13 21:49:27

Hi Pandasandmonkeys

Does his eyelid cover his pupil (the black centre part of the eye)?
If its just a mild inflammation you could use cooled boiled water and a bit of cotton wool to clean the lids, and if persists then i would be heading back the GP.... smile

Your very welcome chislemum grin

Hi clarkykitten,
In our dept we would only give bifocals to a child with a convergence excess esotropia. Do you still see a squint when your son looks at something far way (further than 6 meters)? Do his eyes look straight when he is looking at something up close through the bifocal?
If he is the squint that i mentioned above, the bifocals are given to encourage him to use his eyes together at near. Surgery can get carried out at any age. If it is cosmetically poor then most eye Dr's would aim to operate prior to starting school unless they have a specific reason to wait.

housesalehelp Wed 09-Jan-13 22:09:47

thanks cheekyginger - and thanks for the very useful thread - he has had his glasses a few days and likes wearing them - so I wonder if he is seeing better - however he had managed to stretch the arms a bit - do you think I should take them back to the opticians - they stay on ok as they have the hooks over the ears - is the age things for surgery based on how the child can communicate about what they can see?

cheekyginger Wed 09-Jan-13 22:22:25

Hi Houses,
Surgery is based on the measurement rather than their vision. If a child is having patching treatment for their vision then surgery is best left till this is completed, otherwise no, its the measurement that's important.
The hardest part is the measurement using the prism bar. They tend to loose concentration during this part as there is so much equipment in front of their face and unfortunately that's the bit that is really important for the surgery!

Calelle0408 Thu 10-Jan-13 07:53:28

Hi Cheeky Ginger, I commented on this thread (precious page) I am not sure if I have missed your reply :-( X

Calelle0408 Thu 10-Jan-13 07:53:55

Oops previous page x

clarkykitten Thu 10-Jan-13 08:34:03

Thanks cheekyginger, I haven't noticed if DS squints when looking in the distance, will have to check. I certainly notice it when he takes his glasses off and I am about a foot away from him. He doesn't squint at all with his glasses on that I have noticed. He started school in September so now I am a bit unclear as to why they haven't decided to operate as yet? It's all a bit of a minefield but I wonder if it has something to do with the fact he has a squint that goes both in and up, so they might want to stabilise one of those aspects first?

Catsu Thu 10-Jan-13 10:59:21

Wow, what a really useful thread, thanks so much cheeky ginger!

My dd is 16 months old. She has has glasses for just over a month now.
When we were told she needed them it was a bit of a surprise and I didn't ask any questions but now I am wondering...

Her prescription is +7 in both eyes. Her glasses prescription is +3.5 in both eyes, they said as it would be too much to start her off with the full strength glasses and also to encourage her eyes to still try hard and develop.

Does this mean they will gradually work her up to the full prescription? Or will she always have glasses that only half correct her vision until her eyes stop developing?

Also, will she always have to wear glasses? Or because she started them so young might it 'correct' her eyes over time?

Thank you !

Albaba Sat 12-Jan-13 18:27:11

Hi Cheekyginger. I would like to ask a question please. I have a 16 month old daughter who has a squint in her left eye. Basically the HV picked it up and it was picked up at the development clinic. At first it didn't seem to be that noticeable but now it is really obvious. We were seen by an orthoptist last week who said that the left eye was bad but it was also alternating with the other eye as well but this was good as her vision was equal? Also she was sick at Christmas and looked like she was cross eyed. They thought that she was longsighted but had her eyes tested and her vision is fine just she has this squint. Her distance right was: sph +075, cyl -075, axis 180 and left was sph +200,cyl -125 and axis 180. They have recommended that she gets Cendro glasses and have referred her on to a Paediatric Opthamologist. Can you help make sense of what all this means? I am concerned that it is not just an eye problem as she also has development delays and is waiting on an MRI scan. Also they said that apparently here they don't operate here until a child is 4. Apparently this is a routine op but my daughter also has a heart condition which would put her at greater risk under annasethic. Thank you. Albaba.

cheekyginger Sun 13-Jan-13 22:02:25

Sorry Calelle0408, I seemed to have missed you post first time round!

Your DD is anisometropic. Which is the fancy way of saying an unequal prescription. Its llikely one eye will have slightly weaker vision a.k.a lazy eye. Generally children can need up to 16 weeks to get the full benefit from the glasses. So patching only tends to be started once the vision stops improving with the glasses. So your Lo might not need patching if her vision becomes equal with the glasses.

It is likely she will always need gls. She may not need to wear them full time as a teenager but for any kind of closework she will be much more comfortable with her gls on.

(Sorry if i have it wrong and its your son...confused...i cant look back otherwise i'll lose all my msg!)

cheekyginger Sun 13-Jan-13 22:04:47

Hi Catsu,

They will gradually increase the strength of her glasses. But they will decide the speed of this based on her glasses readings. They may want to do the test with the drops every 6 months just to monitor her prescription OR they may leave her in the weaker prescription for a year....

cheekyginger Sun 13-Jan-13 22:05:48

and Catsu..... if her prescription stays around +7.00 then yes the glasses will be long term.

cheekyginger Sun 13-Jan-13 22:13:05

Hi Albaba,
An alternating squint is a good thing, as both eyes are working 50% of the time therefore the vision will not get lazy on one eye. Which happens when a child squints constantly with 1 eye.
Your daughters prescription is minimal in her right eye however she has a stronger prescription in her left eye, therefore by giving her the glasses they are hoping to avoid her vision becoming lazy in the left eye. As her left eye will be slightly blurring without the glasses and she may start to prefer to look with her right eye. Hope that makes some sense confused

As for the squint operation. That is really at the discretion of the eye Dr. Most eye doctors would prefer to wait till about age 3 or 4 as the surgery can be much more precise. The older the child the more accurate the pre-operative measurements of the squint.

Calelle0408 Mon 14-Jan-13 17:43:17

Thank you cheeky ginger, Absolutely brilliant thread x

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