Newborn - Squint, Duane Syndrome?

[GeneralIdea]

My dd was born just over 3 weeks ago. She has a squint in her right eye with it constantly looking in towards her nose. It's very noticeable, especially from a distance. The hv spotted it and said to monitor it as it should disappear by the time she is 3 months old (although the midwives didn't not anything at birth or at 5 days).

I've been watching for the last week and her eye never straightens, it's always pointing towards her nose. It does 'move around' to some degree, but only small movements, and it never moves to the point that she is looking straight ahead in that eye let alone towards her ear.

Is it normal for a squint to be that severe? I've googled it and it suggest it needs referral if it's constant even in newborns. It also mentions things like Duane Syndrome that I'd never heard of but now I'm terrified she's got a problem.

Her left eye is working fine and tracking objects.

I called the health visitor who said to call my GP.. who told me to call back Friday!

Has anyone had experience of this as I'm losing my mind? 😫

I haven't experienced this but, from what I know, it's great it's been spotted early on as there's more potential something can be done to improve it.

Try to stay away from Google. It does terrible things for your mental health when looking up ailments.

@GeneralIdea
Was it a forceps delivery?

My lo was a forceps delivery and had similar. It took quite a while to go but did.

My DD had a squint when born, and it was very noticeable. Sure enough, by the time she was 5 months ish only I noticed it, and by 8 months ish even I didn't.

Do get it checked if you're worried, but my experience was totally fine!

That's positive news, glad she's grown out of it! Was your DDs squint always present or were there times she could look straight as well?

My LO was born unassisted, although did arrive at some speed which left graze marks on her skin and around her eyes (all of which have now gone).

@GeneralIdea I honestly can't remember - she's only two, but that tells you what a non-issue it was!

Sounds like you've done some good googling.
Your GP needs to refer to ophthalmology.
It tends to be one of those things rather than associated with other eye problems, but it needs to be thoroughly checked out.
It could also not be that, newborn's eyes don't work that well, but it needs to be investigated.
Your GP will probably not have heard about it, so it may be worth printing something out to take with you.

@underneaththeash thank you. I managed to get into my GP this morning who, without prompting, accepted it wasn't his area of expertise and that it needed to be referred to Children's Services Ophthalmology. He's done an urgent referral so at least it's in progress.

Can a inward squint in one eye stop the eye moving much, or is more likely to be immature muscles or Duane?

Some babies will squint intermittently during the first few months of life but if it is there constantly needs to be referred straight away. The most common type of convergent squint in very young babies is an infantile esotropia. Duane syndrome is much less common and there is limited abduction of the eye (outward movement away from the nose) sometimes there can also be limited adduction ( inward movement) as well . Duane syndrome very often doesn’t cause any squint looking straight ahead but is seen when they try to abduct the affected eye. (I’m an orthoptist)

Thank you! It’s been referred as it is a constant squint, there’s a bit of movement but no more than a few mm horizontally. Vertically seems far more mobile.

If it is infantile esotropia can that be treated well enough to give my LO good long term vision or is it always going to be a challenge for her?

I hate that I worry so much, I know there’s nothing I can do but it’s just consuming me night and day 😣

If you cover the other eye does it straighten and then follow. Most babies with a squint have eyes that are otherwise healthy , occasionally the squint can develop as something else is stopping the eye seeing for example a cataract. Once your daughter has been examined they will be able to give you lots more information. I know it is very difficult not to worry but but most squints do not have an underlying serious cause, infantile esotropia is often treated by surgery when the baby is young.

When covering her unaffected eye the other eye still doesn't straighten and follow which is what caused me to start the referral process in the first place. She doesn't seem all that bothered covering the eye with the squint, but covering her unaffected eye she's always busy trying to eat whatever is covering it.

Her eye does appear to be moving more each day so part of it is hopefully due to being 4 weeks old, but the lack of following objects is what really concerned me.

The GP did a test to see if there were red reflections in each eye with the lights dimmed, and whilst he didn't get a clear view he said there were red reflections in both (whatever that's for).

Does the lack of straightening / following when the unaffected eye is covered suggest it's more likely to be a more problematic cause?

I have a squint, only have peripheral vision. Has caused me no issues other than I’m a bit shot at ball sports as judging distance is an issue., I drive without problem-I leave too much room rather than crash!

If she doesn’t like you covering the other eye this suggests the squinting eye isn’t seeing as well and isn’t moving to take up fixation this should be dealt with as an urgent referral so hopefully you will be seen very quickly. When you are seen at the hospital your daughter will have dilating eye drops so they can examine inside the eye. You did the right thing pursuing this referral as even a tiny baby should never have a constant squint

@Rodders92 her ophthalmology appointment is next week so hopefully they can tell me what it is and I can start to stop worrying constantly about it. I find it really detracts bonding as I just always fear the worst and get reminded every time I pick her up or feed 😔

In more positive news she started using her affected eye more over the last week and on a couple of occasions has been looking straight ahead. That said there’s still no movement passed centre and a lot of the time just smaller movements whilst still looking towards her nose.

In your experience can these issues be fixed to the point babies can go on to grow with normal vision or is it more likely to cause vision/development problems?

Hi, it's understandable that you're worried - but you're doing all you can and it's good that her appointment is soon. My son also had a squint from birth & was in glasses at 7 months so I can empathise. While it's really important to get to the bottom of this medically, your love, care & nurturing are also equally important. You also only just gave birth & you sound like you're feeling a bit low - if you think you might have PND or anxiety/ depression please speak with your GP as there are meds which can really help. Take care of yourself, you're doing great.

Hi OP sorry this is causing you so much distress at the moment. I am glad your appointment has come through quickly so you will get some answers soon. Most babies with a squint do have normal healthy eyes with the potential to develop good vision in the squinting eye with treatment. There is a very small chance that there is an underlying cause for the squint but we can only rule that out once she has been examined. It is natural for you to worry but as Blackswan has said if worrying about this is affecting bonding with your little girl do talk to your GP

Thanks everyone for your support, you don’t realise how much it helps.

I managed to get in to see the Ophthalmology team 2 days earlier than scheduled having received a phone call with a change of consultant rotas.

LO had a full check over by an Orthoptist, Optometrist and Ophthalmologist with the end outcome a confirmed infantile esotropia in her one eye at approximately 40 prism dioptres, but no underlying conditions identified.

The consultant hasn't ruled out a sixth cranial nerve palsy or Duane Syndrome as he wasn't able to get her eye to look towards her ear as part of any of his tests, but he didn't refer for an MRI as there weren't any other concerning factors and didn't want to subject DD to the risks of general anaesthetic without more cause.

I’ve got to go back in 4 weeks for the same again to see if there has been any change which the Dr was honest about and said it will probably be the same still in his opinion.

He said surgery is likely needed at 6 months, and may need multiple surgeries, but did say she would never get 3D vision even if corrected which is a bit upsetting.

He mentioned some surgeons will operate at 3 months to give a potential better outcome but in his opinion it didn’t offer more benefit over the risks. Having done some brief research, it seems varied on what’s best and what’s not.

The positive from today at least is there is nothing sinister suspected.

I’ve also made an appointment with my GP as this stuff gets on top of me far too much. DH takes it all in his stride which frustrates me as to why he’s not worried, but when I take a step back he’s the one doing better in this.

@Rodders92 with the above is there anything you'd recommend I ask when I next go back? Is the lack of abduction in her one eye a red flag or can that just exist with infantile esotropia? Also in your clinics do you see better outcomes with surgery at 3/4 months compared to waiting 6/8 months?

Thanks everyone again.

with an infantile esotropia it can be very difficult to get them to abduct the eye even if the movement of the eye is not actually restricted. Babies with infantile esotropia will often have an alternating squint which means that it swaps from one eye to the other and in that case they tend to use the right to look to the left and vice versa to avoid abducting the eye , this is called cross fixation. A congenital 6th nerve palsy would give a convergent squint but is comparatively rare. It is good news if they haven’t found any underlying pathology. Early surgery to correct a squint is often suggested to try and give the baby the chance of binocular vision however most babies who squint from such a young age do not end up with binocular vision even with early surgery although the alignment of their eyes will be significantly improved. Sometimes they may use a swinging baby test , supporting the babies head and then moving the baby side to side to see if the eyes move while they are looking at you. When she is slightly older it will be easier getting her to follow and then see whether the eye moves outwards .

www.researchgate.net/figure/Performing-the-spinning-baby-test-in-a-clinical-setting_fig3_328461287
link to swinging / spinning baby test

Two of my children had bad squints at birth. One grew out of it by their first birthday . The other has surgery at 23 months and again as a teenager ( I think they do the first surgery much younger now ).

My son does not now and never will have binocular vision. He has worn glasses all his life. But apart from this his life is pefectly normal.

No he can’t be an air traffic controller or a pilot and he will never win Wimbledon or be a professional footballer. And he’s not even passable at racquet sports . But otherwise he can do anything and be anything he wants.

Please try not to worry OP. There’s nothing you have written that indicated it’s likely that your baby has any serious problem. . Surgery to correct the squirt ( if that’s what’s indicated ) is very minor and very successful and baby will be over it in a few days. She may have a bloodshot eye for a few weeks which looks awful but won’t bother her.

I understand your very real distress and how upsetting it is when she looks at you with one eye. I know it hurts you when other well meaning people make comments about it . But please PLEASE don’t let this spoil here precious first few months for you both.

Your baby is perfect just the way she is . And you are the best mother in the world for her .

I've had a squint all my life. Never been operated on. I struggle with ball sports like a previous poster said but otherwise it makes no difference to my life. I drive, i use computers for work. As a teenager my biggest concern was whether I'd ever have a boyfriend😂. Rest assured that was never an issue and happily married. Baby girl does not have a squint.

I was born with a squint plus other eye problems. (I have a condition called Nystagmus plus an undiagnosed eye condition) I've never had surgery and one of the people who saw me at the eye infirmary recently did say this was a good thing. I think he said it can come back or causes other problems.