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.

Thank you for this OP.
ds1(8) has a squint and has patched, under local hospital. They recently suggested discharging , to local optician. Fine, But I was not happy. They will not operate, saying that he is not that cross eyed, he's not that bad, but i found them just too dismissive of the aesthetics of how bad 'looking' my ds's eyes sometimes are. I know that the vision is the most important thing. I know its only cosmetic. But lets be honest, if we all finally admit, that sometimnes, being cross-eyed can be a little bit, well, disorientating , or odd looking, or even, can I say it, a tiny bit disfiguring really. I know thats harsh, but it makes my heart weep when my son who hates weraing glasses, ( He will always need glasses)(he is the only boy in his year who wears glasses), and begs for contacts. But I am thinking that the galsses actually hide his cross eyed ness quite a bit. And if you only had contatcs , it would make his cross eyed ness even more obvious. I feel neurotic and pushy when I try and explain this to the consultant, but I am onyl fighting for my son , making sure I have done all I can for him ( I fought for 2 eyars , to get him diagnosed as Aspergers, not just my 'crap parenting', so I am all for fighting).
I am not even sure if surgery would be best, maybe not. can anything be done through vision therapy, and all the exercises that they seem to favour in the US, to try and get to the core problem rather than just haveing 5 or 6 surgeries to correct it, like they do in the UK? I don't know. But i would kick myself if i later found out there was more I could have done for him, had I known. Please advise.

Hello again! Just catching up, glad to see you are still here .

Took DS for his appointment today and found out he has a small squint and a lazy eye -probably caused by the squint. The lazy eye is hmmm not sure if I've got this right, 4 times worse than normal vision (?)- well certainly he couldn't read the medium sized letters she showed him with that eye but could do them easily with the other. Unfortunately we have to be referred on again before he gets any treatment and that appointment isn't until the end of March. Rather frustrating, but I'm hoping another couple of months won't make too much difference to treatment- he was 5 in October.

So treatment will probably be patching and maybe/probably (?) glasses too as may be long sighted. For the next appointment I have to put drops in his eyes before it, not looking forward to that!- any advice/tips? Also I have been advised to get my daughter (3) tested as squints can run in families. My sister had one as a child but hers was very obvious whereas we hadn't picked up on DS's at all- so pleased the screening picked it up.

Thank you so much for the reply Cheekyginger. I think that's the first time I've understood what's happening in 4 years of hospital appointments! Much appreciated.

Cheekyginger - just wanted to pop back & update. We had DD's appointment the other day and it went very well :)

Her left eye does tend to 'drift' but it is not a concern & we have to go back in 6 months just to be sure.
She was a star for all the tests :)

Thanks on behalf of everybody you're helping.

Oblomov - you sum up how I feel about my DD :( However, I have been told by cheekyginger and DDs orthoptist that contacts will have the same effect as glasses - ie, if the eye doesnt wander with glasses on then it wont with contacts in :) Fingers crossed. DD is only 5 so cant test it yet but my heart weeps when I see her eye wander...

Thank you Vye. I know it sounds terrible, but it does make me sad that ds is cross eyed. I just don't want him to be taunted at all.
But I hope you are right and the contacts will hide it.

Hi Cheeky Ginger,

chuffed to find your thread.
I am longsighted and our kids have been watched by orthoptics every six months since six months of age. DD 3.5 has +2.25 in each eye and has been told to wear glasses. she has been 2.25 for a year. The appointment was really rushed with my 1 yr old going mental through most of it. The Optician asked me if she stood close to the tv when watching I said yes and he said she ought to have glasses then.

Dh thinks it might make her eyes worse if she doesn't really need them. I think why should we hold her back in education etc if it would improve her vision. Im Feeling really confused, please advise if you can.

Hi cheekyginger, thank you for this thread.
My DS, 3 months, was born with hydrocephalus, so his eyes and eye movements have never looked 100% normal. His eyes have always flickered around and he sometimes had 'sunrise' eyes with white showing above the pupil.
He was treated when he was 8 days old with a surgically fitted shunt, which is working well, so the excess fluid pressure on his brain is gone.
The sunrise effect is less, and he can track objects with his eyes, but he now has a squint. It isn't stable, either eye might turn in, depending where he is looking. At the moment it is more often the left eye.

DS also has short periods where his eyes flick all around and don't seem to focus. He did have an eye check in the neo natal unit before his op and they didn't spot anything for follow up there.

Phew, long background! My question, besides a general interest whether you have come across hydrocephalus related vision problems in your work, is really about referral. I'd really like him to see an eye specialist like you. I saw the GP yesterday and she said they wouldn't refer, he is too little and the presentation of the squint wasn't consistent enough. Also, that as it was likely a residual effect of earlier problems they'd leave any referral to the specialists who'd treated him, which is fair enough.

At what age do you start assessing and treating babies?

We do have a follow up next week at the neurosurgery clinic in Great Ormond St and I'm keen to be able to ask the right questions about DS vision, squint and eye movements and get referred in to a specialist. They are great, but they are so busy and time with the consultant goes so quickly! I've videoed one of DS spells of flickering eyes/eye turning in. Is there anything else you think I should be ready with?

Hi Destination unkown,
If he has had his eyes tested then its unlikely to be a true squint. By what you describe it sounds more like what we would call a pseudosquint, a "fake" squint. It will likely be an optical illusion caused by the shape of your LO nose or shape of his eyes etc.
If you feel you are noticing it more often or when you are looking straight at him then definitely take him to your local optician.

I'll be back asap to answer the rest of the questions asap, now i must sleeeeep!

Hi Oblomov,

Im sorry to hear that you are finding it all very traumatic. The eye Dr's make their decisions regarding squint surgery on the measurements of the squint rather than what it looks like. Your child may have a squint that doesnt measure a lot (even though you feel it is "bad") therefore any surgery may result in an overcorrection of the squint and the eye would turn the other way. Your child's face is still growing and this may alter the appearance of a squint as his face grows. Convergent squint tend to look slightly smaller with age.

If you are not happy you could ask your GP to refer to for a 2nd opinion, but be prepared to hear the same thing.

If your DS does not have any binocular vision (3D vision) then eye exercises would not be an option. In the uk the vast majority of childhood squints require 1 operation. If it is a very large squint then a 2nd op will be required.

Hi Tggr,

Well done the screening!!!

Our policy for the glasses check is within 6 weeks but march will be ok. They will likely get the glasses going first then start the patching once fully settled into the glasses.

If you were desperate to get seen sooner, you could stop into any high street optician. That might be a bit naughty, but you could have glasses within a few days. This wouldn't affect the treatment at all. Your son could still have the glasses check done at the end of March and they can do any fine tuning they think is required. But don't tell them i said that!!!

Thanks v much cheekyginger - great advice.

Hi stripeysock,
A child standing close to the tv is not an indication for glasses. Were you referring to your 1 year old or your 3.5 year old needing the glasses ?

I would recommend a referral an orthoptist at your local eye clinic prior to getting glasses for a 1 year old. Giving glasses at this age is only really required if their is a big difference between the 2 eyes OR if the prescription is really high (>+3.00). This should really be monitored by an eye clinic so that glasses are not prescribed when your child is too young but also so they can be given if the prescription doesnt reduce over 6-12 months.

If it's your 3.5 yo that requires them then the glasses would be good. We recommend glasses for full time wear. The glasses will not make her eyes worse....

Hi specialagentmeh,

Assessment at this age is all about observation and no babies are too young to be referred. However, your neuro surgeons may suggest to wait for a while before referral, as babies eyes are really un-co-ordinated until about 6 months of age. They might want to wait for a wee while to see how your LO's eyes settle. The ophthalmologist (eye Dr) wouldnt do any treatment at this age anyway.
A video clip is excellent, its the quickest way for the Dr to see exactly what you are seeing. Once the hydrocephalus is under control then his eyes will hopefully "stabilise"....good luck with your appointment

Thanks very much cheeky ginger. Our appointment is on Monday, will keep you posted.

Thankyou for your reply.
It was the 3.5 yr old, we are seeing the eye clinic.
I thought they wouldn't make her eyes worse but my partner was convinced they would.
You helped clear that one up. x

Thank you so much for your response OP.
When my son does not wear his glasses, I see how badly cross eyed he is. I see it at its most natural. And that I hate. I know it may not be 'THAT' bad to a consultant, but it 'looks' very very bad to me.
Your response hasn't helped, IFYWIM. But I do appreciate it. Thank you very much.

Oblomov - just sent you a DM as we are in same situation....

Hi Oblomov and EustaciaVye,

Sorry i cant give some more positive information.

The only other advice i can give is that some children can learn "misty/clear" a trick to help the eye stay straight without their glasses on. They have to be of an age to be motivated to try it
I will have a go at explaining it!!!!
Sit in front of your child and lift their glasses up just out their line of sight....initially their eye might be very briefly "straight". If this is the case then you can teach them to "use" this. When the glasses first get lifted up their vision will immediatetly be misty and when they focus to make it clear the eye then squints. So you can teach them when their vision is misty (without their glasses) their eyes will be "straight", but when they focus their eye to make their vision clear the eye then squints..... This is not an exercise, it is purely a trick of the accommodation of the eye to change the position of the eye for short periods of time and allows the eyes to look straighter.... Hope that makes some sense?

Thanks cheekyginger! I think we will wait. Not keen on two lots of testing...... will let you know how we get on come March. Thanks again. Great to have this thread.

No probs Tgger, good luck with your appointment

I had this on it's own thread but just found this thread now and would appreciate advice - her perscription is R +4.5 L +4.5

Hi everyone this is my first post on the site!
I am wondering if anyone uses contact lenses for their children. My DD is 5 and has been wearing glasses for 1.5 years. She has a squint but needs glasses for sight too. She has really long eyelashes and I have been through loads of different frames but they all squash her eyelashes against the lense(as it is her eyelashes already grow sidewards from being squashed up against the glass)

Added to this she has a slight hip impairment that makes her trip often and the glasses fall off or go flying and I'm afraid they will smash on her face or get walked on in the yard (she only started school this year) So thinking contact lenses might be an option but never heard of this for a younger child. Will her squint go away because as soon as the glasses are off - for bed, swimming it's there immediately Anyone any idea's?

Hi priorknowledge,

It's unlikely any optician would give her contacts at this age, but never say never. You could phone around opticians in your area. It would really depend on how keen your DD is to wear them.

The type of squint that you describe is a fully accomodative squint, which means the glasses fully correct it. In the future contact lenses will have the same effect as the glasses. In the meantime, prescription swimming goggles may help around the pool.

If you have a look at the post 3 before yours i attempt to give an explanation of teaching misty/clear a technique to help keep the eyes briefly straight without the glasses. Tricky to describe in writing!

Thank you so much for your advice cheekyginger you are so good to share your expertise with us.
Just wondering why the opticians are slow to prescribe the lenses - is it because they can't manage them or the risk of infection (I was thinking of disposables) or are they not as good as glasses for the actual sight.
She does martial arts and looks to be heading for national level so trying to get ahead of myself for the future - maybe the goggles would work but I can't see her wanting to wear them on the mat. She isn't aware of her squint yet so the misty eye thing isn't an option but I have made a note of it for the future for her.

Cheeky Ginger, it's very good of you to give us your advice!
DS1 is 4 and has been attending the local eye hospital since he was 18.5 as his childminder had noticed his eye turning out.
His vision is broadly normal (don't have numbers but he doesn't wear glasses!) but his squint is not improving. At the last appointment, the consultant told us that he would probably need an operation and that this would be done when he was 5.
I did query if this was purely for cosmetic reasons but the consultant said that if the operation was not performed it would eventually start affecting DS1's eyesight.
While I'm a bit scared of DS1 going under a GA, I'm happy for him to have the operation, but curious as to why patching isn't a possibility?