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

[cheekyginger]

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.

If no-one in the immediate family is short sighted, then there is no way to truly predict what will happen to his prescription. Short sightedness does tend to worsen over the teenage years.

The only thing you can really do is not to over wear the glasses. However if the glasses help with the control of his eyes and your optometrist recommends that he should be wearing them full time then you should go along with what he/she recommends.

First of all, thank you for offering your help with this. Can't believe I stumbled across this thread.
My daughter Lily will be 5 on 16 June 2013 and will be starting school in August. She visited an Orthoptist for first time yesterday and straight afterwards an Optician who prescribed glasses. The Orthoptist confirmed that she did has considerable reduced vision in her right eye with a very small quint (not always apparant). She confirmed her left eye was great. The optician recommended the following prescription:
Right: Sph +3.25, Cyl +0.75, Axis 90
Left: Sph +2.00, Cyl +0.50, Axis 90
I need to take her back early April for a review.
I was really confused by all the complex talk yesterday and now I have many questions running round in my head. I'm basically keen to know, why my daughter has been prescribed glasses and was the outlook is. Will she hopefully eventually be able to do without them if she wears them religiously as asked or is there no guarantee? Are the glasses to help her focus which hopefully in turn will help the quint?? Can the glasses indeed make the quint worse? Sorry lots of questions and I've probably got more but if you help me at all, I'd be most grateful. Regards

Hi cheekyginger - me again! Just to recap, DD6 has intermittent squint first spotted at age 3. Has had a year of glasses which made no difference and barely had a prescription - she stopped wearing them 9 months ago. Her diagnosis at the moment is:

"Constant left/alternating esotropia with slight accommodative element - low hypermetropia
Potential for abnormal binocular single vision at reduced deviation"

We've seen the consultant twice now and he is reluctant to operate as the squint is intermittent. He had her eyes tested again thoroughly last week and we had to put the strong atropine drops in her eyes for two days (her vision is still affected over a week later!). He had a suspicion that she may be long-sighted but she isn't.

His next theory is to test her again in 2 months and he is going to explore the fact that there is something going on with her eye muscles for close-up work. He says they may explore her wearing a type of pair of bi-focal glasses with plain glass at the top and a lens on the bottom half that "pulls" the eyes in the right direction. From what I gather this would train the eyes to behave as it were (laymans terms!). Wondered if you could elucidate further? There was much chat between him and the optometrist about the "accomodative" element that I couldn't understand at all!

Thanks

Hi polilyzoe,

From the prescription you have written down it looks like your DD is longsighted with a slightly stronger prescription in the right eye.

By "quint"??? Do you means squint/turn of the eye?

If she has a squint then she will need to wear her glasses full time to see what effect this has on the squint and also helps the vision to reach its maximum potential. If you DD's vision in her right eye remains poorer than the left then your orthoptist may prescribe patching to treat the amblyopia.

As a very general rule any prescription over (sph) +3.00 is said to be long term, so it is likely she will need them longterm. But if her prescription changes as she grows then that might not always be the case.

Lots of "ifs" im afraid! You'll be able to ask lots of questions at your next appointment. Even write them down so you remember on the day

Hi cartblanche,

The bifocals will allow your DD's focusing to relax when she is looking at something up close and this will encourage the abnormal binocular vision

Have a look at the convergence excess paragraph on this page under the sub heading Accommodative Esotropia Your DD isnt a true convergence excess but they are obviously trying this to see if they can re-inforce her binocular vision.

Hope that helps a bit!

My son has occular albinism (this means he has a squint and nystagmas also) and really wants to go and see a 3D film over half term for his friends birthday. Is this ok for his eyes? I realise he will have to also wear his normal glasses under the 3D ones n it may be a bit uncomfortable but I don't want him to go and end up feeling ill or his eyes hurting but I also don't want him to miss out? He's 7. What would your opinion be?

Hi Cheekyginger, thanks so much for getting back to me regarding my Lily. Sorry I can't spell, yes she has a squint/turn in her right eye but it's not very noticeable and sometimes you don't even notice it at all.
By longterm do you mean years and years?? The orthoptist I saw said that she can't see any reason why it cant be fixed but not sure if she is referring to the squint or her vision. She mentioned age 7?? Any further comments would be most welcome. Regards Pauline

Hi Samr85,
He should be fine. He'll need to wear the 3D glasses on top of his own otherwise the screen will look funny. The 3D glasses are quite big so should fit over his gls no problem. He shouldn't have any ill effects from it!

Hi pololyzoe,
Longterm tends to be a gentle way of saying forever. However this is not set in stone as her eyes can change as she grows. It would be unlikely for her to "grow out" of this prescrption altogether but it could reduce. Think the orthoptist was maybe referring to your DD's vision. The vision can be treated up to the age of 7 (In my department we tend to say age 8/9 as the visual pathway of the brain is still plastic up until this age).

Can anyone help me to understand about lazy eyes / squints please? I am so upset, my daughter has just developed a squint in her right eye, this has only just happened in the last 2 weeks. My daughter is 20 months old. Have been to an Opticians, and the outcome is she is long-sighted in both eyes (+5 in both eyes), and due to being longsighted has developed a slight intermittant squint in her right eye. They have said she needs to wear glasses all the time and for the rest of her life. They said if she doesnt wear her glasses all the time then the squint will get worse and she could lose her sight in that eye. I am currently at the stage (in a couple of days) of choosing her glasses. We are also being referred (to a hospital). Can anyone give me any advice at all about squints, whether this will get better in time?

Dear Cheekyginger, I'd be very grateful for a bit of your valuable advice please.

DD is 5, she is longsighted with astigmatism. She has been wearing glasses since she was about 3.

At the previous eye clinic appointment, the opthamologist said she had been making good progress and reduced her prescription by half a dioptre(?) - from +3.0 to +2.50.

At this check up with the orthoptist, her vision had got worse. They checked her glasses and discovered that somewhere along the line the wrong prescription had been given or fitted in one lens for dealing with the astigmatism.

DD should have had R +2.50/-1.50 x 150 but what she had been wearing for the last 6 months was R +2.50/-2.50 x 151. The L lens was ok.

I wasn't at the appointment and Dh says that the way they described it, the prescription means an issue for the brain processing part of the eye problem and that as she's still younger than 7, they hope it will even out again eventually.

What problems will it have been causing her do you think? She's started school with this prescription in so has been learning to read. Are there going to be any long term negative effects or is it likely just to sort itself out?

It's unclear where the error was made. The optician works in the eye clinic and says he made what was on the prescription voucher.

She has a corrected pair now and we have to go back for a further check up next week.

sorry, forgot to say thank you!

Hi SunshineDeb,

Your LO is moderately longsighted. Once you get seen at the hospital the Orthoptist will be able to tell what type of squint your DD has. When a child is longsighted and have an intermittent convergent squint then there are a few possibilities

1. the glasses might not make any difference to the squint
2. the glasses may make it smaller but not completely correct it
3. the glasses may completely correct it (she will still squint without the glasses though) If an intermittent squint is left untreated then there is a risk that the vision will become extremely lazy in that eye. But you sound as though you are in good hands

Hi AuntieBulgaria,

These things happen quite a lot

The prescriptions are often hand written by the Dr or the optometrist so they can sometimes be misread....

It will not have caused any lasting problems. It would have caused a little bit of blur. But her vision will return to normal with her new glasses

Thank you, that makes me feel better. Because I wasn't at the appointment it was difficult to get a sense from DH as to the severity of the issue.

Hi Cheekyginger,

I would welcome some help and advice. I am very worried about my DD (2y5mo). We noticed her squint intermittently last October. Her eye would literally 'shoot' dramatically upwards and inwards when she tried to look from far to near, or turn her head suddenly. This seemed to happen overnight.

Since being seen by the Opthalmic surgeon at the end of Jan she has been diagnosed with a right superior oblique palsy (AKA 4th cranial nerve palsy for other Mumsnetters). She does sometimes have a compensatory head tilt and chin tilt (tucks chin in, and tilts head to the left).

Her visual acuity was 6/7.5 right and left by Cardiff cards, and she has been given some glasses +1.5 right eye, and +1.0 left eye to see whether these can help. She won't really keep them on, except at nursery (!) and when they are on, she just tucks her chin in even more to look over the top of them.

I am a medical professional (anaesthetist), and all sorts of things have gone through my mind as I realise this kind of isolated muscle problem is rare. She had one minor head injury at the beginning of October when she fell off forward from a scooter at nursery and hit her head on the left above her eye brow splitting the skin.

Some stuff on the internet suggested that such minor head trauma wouldn't in itself be enough to cause such a problem. Her elder sister had a wandering eye when she was about her age, was seen by an Orthoptist, and then it got better. My mother said that I had a 'lazy' eye when I was a toddler, but that it got better. I am now short sighted (-2.5 left, -2.25 right) and have a slight astigmatism in my right eye. My took our DD to hospital and didn't ask many questions when there - he isn't medical>

Is she destined to have surgery? Should I worry that there is something more sinister going on?
We are not due to be seen again until the end of April.

Thanks for your help cheekyginger

Hi gaschick,

Sounds like your DD has a congenital superior oblique weakness. (Cong 4th nerve palsy). Although you only became aware of it when she was over 2 it will likely have been there for longer. If the ophthalmologist had though there was anything more sinister going on then he/she would have arranged an MRI there and then. They wouldn't mess about.
The glasses she has been given are quite a mild prescription so they may not be forever. The glasses will not change the muscle imbalance but they may help her see a little better and in turn may allow her to control her eyes better.
If she is using what we call a compensatory head posture then that is another reason to presume this is congenital. She is adapting to the muscle imbalance
and "compensating" by moving her eyes away from the area that the imbalance is at it worst.
If she is managing to use her eyes together and her vision is not becoming lazy in one eye then they may decide just to observe her at present. If her compensatory head posture was to increase in size or she was to start squinting when looking straight ahead then surgery be carried out sooner rather than later.
You may have more questions after you next appointment in April If all is stable at your next appointment then they may leave you longer next time.

No probs SunshineDeb

Hi, i would really love some advice. A few months ago my DD, now 28mnths, started to show signs of a squint. her left eye would turn in to her nose randomly. we went to the drs and were referred. we have since been seen. Needless to say, she was far from co-operative when the appointment came around and spent the entire appointment trying to hide behind her hands and screaming when anyone tried to get her to do anything. They agreed that there was indeed a squint and then when seen by the specialist

( opthamologist?) we were told that she was long sighted and given a perscription for glasses for +6. This came as a huge shock, as although we could see the squint, she was not showing any signs of difficulty seeing. she is able to pick small things out in picture books etc. The only thing that we did question was her standing very close to the television. She has now had her glasses for 3 day and she is refussing to look at the television through her glasses. she is still going up to it or looking at it over the top of her glasses. when we ask her why she says she can't see. i know this isn't totally reliable as she is only 2, but it does make me wonder. She was so unco-operative when they were trying to put what i assume were lenses infront of her eyes once she had had the dilation drops in them, is it possible that these glasses are not right? I am probably worrying over nothing, but i would be much less so if only she was old enough to be able to properly explain her self. We were also told at the appointment that she would perminantly be in glasses from now on.

Hi far2busy,

Once the dilating drops are in then the wee one doesn't actually have to be hugely co-operative to get an idea of the prescription.

Unfortunately when little ones are long sighted it can take a while for their eyes to relax and allow the glasses to see for them. Thats why you wouldnt have notices a problem with your DD's vision. The little lens in her eye is very flexible so she can over focus her eyes are see reasonable well. Unfortunately this over focussing makes the squint worse.

The aim will be to get her into her glasses full time. (Looking through the lens). This will allow the Orthoptist to decide what type of squint she has. The glasses once she has settled into them may make the squint smaller (partially accommodative esotropia) or even completely straighten it (fully accommodative esotropia). Once she does finally accept her glasses you might find that you start to see the squint constantly when she takes her glasses off. This is unavoidable im afraid....it just means that she is getting nice clear vision with the glasses, and will now try hard to achieve clear vision without the glasses (over focus).

As for helping her to adjust into her glasses. Encourage lots of close work, colouring etc. She will feel a benefit from them at near easier than she will in the distance. Keep persevering . When is your next appointment at the eye clinic?

Thank you for your reply. I know it isn't the end of the world and people have to deal with far worse, just when it's your little one...! She has been doing better with the glasses today and is keeping them on well after the initial 'I don't want to'. We have our next app at the start of may ( 3 mnths from last) when we have to see the first person again - I'm not sure what her title was, bug we do not need to see thd gentleman who prescribed thd glasses. I have to say our opticians have been fab. They have thinned thd lenses a little to help with the weight of them etc, but decided not to do too much due to cost until they were confident that her prescription would be a little more stable, in case when we do go back it needs to change. ( they also ordered in more of the frames we chose so that they would have them if we needed them! (smile)

Thanks very much cheeckyginger. I have gone back and been brave (I didn't really want to interfere) and spoken to the opthalmologist myself to try to reassure myself. Pleased I did. She has brought forward our next eye appointment. The head posture is only intermittent, when she gets tired, but she then often shakes her head when she is tired as well, violently from side to side, and really rubs her right eye. So, I think her eye bothers her somewhat sp when tired and the squint is worse. The opthalmologist said she was a little young for the decompensation which you described, but agreed that it had prob is congenital, although simce birth her eye movements have been completely normal.

She also said that she would refer her to the paediatrician as well. She has been keeping her glasses on for longer periods of time. Nursery have been really great in this regard. It is still very worrying though, as unlike other types of squint, she is unlikely (my understanding) to have normal binocular vision - this the opthalmologist ageed with - and won't really necessarily be improved with the glasses.

Hi cheekyginger,

Thanks for offering your service. My son is 4.5. He wears glasses and we patch his right eye since May 2012. He has a squint in his left eye, he has a lazy eye and he long-sided. Since May his vision improved thanks for patching, however it is still very far from good vision, but his squint is the some if not worse. He has squint even when he wears his glasses. We spoke to the doctor about the surgery, but it seems it would not help hi squint. So they told me they could not help any more. It means he won't be able to use his two eyes together to get a binocular vision. I cannot believe it. So I asked the doctor about vision therapy, she told me she does not know what it is. Pease could you tell me if vision therapy can help to improve his squint and his lazy eye?

Thanks.