Anyone who can give any advice on eye squints (extropia strabismus)

[Kaytronkit]

My son is 3 and a half and has a slight eye squint now and again if he is tired or thinking his eye can slightly wonder outwards for a few seconds. We are under the hospital and he's been diagnosed with an extropia strabismus. At the moment his vision is fine but they are checking him every four months. I just wanted to know if anyone else has experience this with their child and what the outcome was. And also if anyone has tried visual therapy with any success?

We don't have much experience as we're only 4 weeks in to being diagnosed. My ds started with a sudden squint (turning inwards when tired), his vision is fine but has been prescribed glasses to correct the squint. Has your ds been prescribed glasses?

My ds is nearly 3. He has a squint - one of his eyes turns inwards when he is looking at something closely, tired etc. It appeared about a year and a half ago after a nasty bout of conjunctivitis.

He also has a lazy eye with only 60% vision on that side. For that, he needs to wear a patch over his 'good' eye pretty much all the time. We have been told he will need an operation for the squint before he starts school ( not in UK so around age 5). We have been told glasses don't help him. We are being seen every 3 months.

Dd2 had an alternating converging squint pretty much from 3 or 4 months. She wore glasses from v small and we were originally told she would have surgery early, then they changed their minds. She eventually had strabismus surgery at 7. Becasue her squint was alternating, patching was not appropriate.

Surgery fixed it, but it does occasionally come back when she is tired (now 4 years post surgery). I understand this is not unusual. She still wears glasses.

No experience of diverging squints though.

My dd has a squint - her left eye turns in. It came on quite suddenly so we were quite concerned initially. I also had a squint when I was young but it was very mild (only when I was tired) and i never had treatment other than regular checks. I still occasionally do it when I'm tired. My daughter is seen regularly by a specialist and wears glasses to correct her vision. She is only slightly nearsighted in one eye but the wearing the glasses makes a big difference in her squint. The treatment will depend on the reason

Are they using glasses at all to try and control the eye?

They can inject eye muscle to freeze it in place, think Botox.

My brother had this then later on lazer eye surgery for short sightedness, he never had a lazy eye.

I had a lazy eye and squint, patched surgically corrected. Sucessful

My DC has a micro squint, corrected with glasses and 20/20 with glasses.

I would ask a few more questions, however I do know someone with a wandering eye that does not wear glasses, but eyesight issues don't seem to be on the radar.

DS1 (7) had a divergent squint diagnosed when he was 2. His eyesight is fine and the orthoptist said that he was correcting well. It's worse when he's tired or in bright sunlight. He hasn't needed a patch and after appointments every four months since diagnosis, he's about to be discharged.

My 2 yr old has just been diagnosed with exactly the same thing and with the same treatment plan as you. To simply watch and record the measurement of the squint in 3 months. They have said if it gets worse the only option would be surgery but that 50% stay the same, 25% improve as they get more control over their muscles. The remaining 25% deteriorate and if she falls into this category this is when they operate.
I have mixed feelings as I was hoping it would be something they would be able to 'fix'. When I expressed this I was told not to worry as Kate Moss has a squint!

Thanks for your messages everyone.
Hi Patatas I didbt realise they could prescribe glasses to correct the squint even if their vision is fine, and it's intersting a lot of you are saying about glasses. I will definitely ask about this in a couple of weeks at our next review.

Ilovespinach that's strange you say about the conjunctivitis because it seemed to develop for my son after he has quite a bad virus in his eye. I'm not sure if this was just coincidence or if it can develop after infections. I know they say it's hereditary but no one in our family seems to have a squint that we are aware of.

Reekypear did you have surgery for the strabismus? The surgery worrys me because of the over correction. I also didn't know about the injections so that's a possibility if it comes to that. Yes houseofnerds I've heard that it can return after surgery. Did your DD have surgery in both eyes? Was it completely corrected initially after surgery?

Yes Cherry78 that's the same plan as my son. And exactly what we were told although they never given statistics and they never said it could improve with muscle control so that's good to know. The Kate Moss info they told you that's awful!

Weebarra has your son had glasses? Has it became less noticeable? That's good to know he's about to be discharged.

This happened to my daughter , they won't give you glasses unless there's a persription in the eye, my daughter was normal in one eye and a +3 in the other, glasses stopped the eye from turning , however when her eye turned they said monitor it for 3 months before they did a glasses test, unfortunity it got worse amd she needed the glasses straight the way

Yes I had surgery, but that was many years ago, it was successful, still is.

My brother had his eye injected with Botox, as technology had moved on.

Over correction can be a worry, so I would wait as long as they say, to monitor it.

Exotropia is not usually linked to a need for glasses. Most Exotropia in children is intermittent not constant and will happen more when they are tired, daydreaming or unwell. Exotropia is also worse in bright sunny weather. Most children with Exotropia have good vision in both eyes and when they are not squinting will use their eyes together (binocular vision). Whether any treatment is needed depends on how often it is happening and any symptoms the child has like headaches, eye strain or double vision. There is something called the Newcastle control score which helps to monitor Exotropia and uses info from both parents and clinic assessments. Squints are measured with prisms to decide how much surgery is needed if that is on the cards. Undercorrectiion is much more likely than over correction in Exotropia. Minus lenses can be used to encourage the eyes to converge and help control but this is not widely used in uk, also exercises can be used in some children. There are good explanations for different types of children's squints on squintclinic.com

I know it’s an old thread, but if you are still around @Kaytronkit and @Cherry78, just curious how it went for your kids? And did your kids develop any winking due to it at any stage?

My 3 year old is diagnosed with the same and the same treatment plan is suggested. What has me worried is that he’s developed wink in his affected eye which is very constant. One ophthalmologist suggested it’s a tic, while other is saying it’s related to exotropia and not a tic. I am very confused whom to believe and what to expect.

My daughter never developed a wink but did develop a facial tic, not sure if this was related to the squint. We never had the surgery as it only really shows when she is tired or ill. We still have the option but as she is almost a teenager we are leaving the choice to her.

Thank you @Cherry78 . Was tic something with eyes, like blinking or smth? How long did it last for you?
Your option about surgery sounds good, when it’s so intermittent probably not much point in doing it.

Closing one eye is a common feature of intermittent exotropia and more often seen in bright light, it is also more difficult for them to control the squint in bright light. Some children but not all experience double vision when the squint is present and the eye closing can be to stop this, I’m an orthoptist and previously commented on this thread under a different user name

Thanks. That’s what second ophthalmologist told us too. But still, no treatment suggested. How can you tell is it a tic or caused by exoteopia? That’s very unclear to us.

If it’s due to exoteopia, is it something they will eventually stop doing? We don’t want to have child growing up constantly doing it and no treatment suggested to address it.

@Ennyta the eye closure is due to the exotropia if he is doing it outside in sunlight , children’s sunglasses may help to reduce it , as he is three you could try and find out if he is seeing double at times e.g do you ever see 2 of mummy. Intermittent exotropia is due to them not being able to maintain binocular vision all the time. It is usually most noticeable when they are tired, ill, daydreaming , in bright sunlight and when looking in the distance. Surgery can be an option but usually we recommend a period of watch and wait to get an idea of how well the squint is controlled over time and allow for accurate measurements as the amount of surgery is dependent on the size of the squint. If you look up the Newcastle control score I have mentioned in my old post from 2015 you can use this to get some idea if control of the squint is stable or changing

Thanks @TheOliveFinch . I wouldn’t mind waiting and seeing how it goes, but winking can be so excessive at times. If it stays stable and they don’t recommend treatment, should I expect winking to stop at some stage?
It got me more worried than exotropia itself tbh.

The eye closure can reduce over time , he may not be aware he is doing it and if you were able to see behind the closed eyelid you would likely see the eye diverging behind it. Some parents don’t notice the exotropia but it is the eye closing they see. If the eye closing continues to be a big problem mention this to the Orthoptist and ophthalmologist at your next visit. Other types of treatment that are sometimes tried are minus lenses, base in prisms and these can help but are not often used in children this young. You may also come across patching the eyes alternately but I was never convinced by this or saw it be successful in practice.

Thanks @TheOliveFinch for answering, appreciate it. I really can’t tell if it’s a tic or due to exotropia, which is why I was wondering if others experienced it with their kids.

It started when he was watching tv or tablet, then got very excessive for a month, basically constant, like every few seconds, regardless of time of the day, light or anything like that. Now recently it seems to be more when looking at tv, tablet, looking at the distance or on bright light. He’s never doing it when he’s focused on doing smth, like playing with a certain toy, playing a game in tablet, drawing etc. This is why it got me so confused what’s causing it. And then two different doctors opinions definitely don’t help.

I am still unsure what’s causing it tbh, so it’s hard to know what to expect regarding how long it might last 😬

Just to note, none of the doctors could see exotropia on the exam, they couldn’t induce it, but were able to see it on our photos and videos and that’s how he god diagnosed.
We started noticing it for few months now, then a few other close family members noticed it as well, which is when it became more obvious. But winking started a month ago, so it was after we all noticed it.

so confusing 😶‍🌫️

It will usually be controlled when he is concentrating which is why you don’t see it when he is focussing on a toy. Ophthalmologists tend to be very specialised so unless it is a paediatric ophthalmologist or strabismus specialist they won’t necessarily have a good understanding of squints. Ocular tics tend to look very different to the monocular eye closing you see in exotropia. Ocular tics tend to be a more like an exaggerated wink or blink like you see in some people who have Tourette’s. Eye closure in exotropia tends to be a more gentle movement like you see in a normal blink.