It is perfectly natural as a parent to feel anxious and a little upset by the fact that your child has a turned eye. One of your concerns will be that your child doesn't look nice with a turned eye. You may have noticed that your child doesn't perform certain visual and eye-hand tasks as well as expected because of the eye turn. You may also be getting lots of so called "helpful" advice from your friends and relatives as to what you should be doing about the turned eye.
Understanding the condition
The first thing to remember is that the turn doesn't worry your child very much. They are not in any pain or discomfort and as far as they are concerned they can't see what all the fuss is about. This is because when the eye is turned the brain does not pay any attention to it so your child isn't seeing double. Sometimes when a turn is first developing the child will get intermittent times of double vision but the brain learns very quickly to turn one of the pictures off. This is called suppression and if it occurs long enough then the eye that's being turned off won't function as well in terms of eyesight.
When the eyesight becomes poor this is called a "lazy eye" (amblyopia) and this will have to be treated before we can get the brain to pay attention to that eye. Lazy eyes are quite common in young children. About 5% of children need treatment for a lazy eye.
It's important for you understand that your child's eye turn is not your fault. It's nothing you did to your child that made their eye turn.
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Why did my child develop an eye turn?
There are a number of reasons why an eye may turn. As a result the treatment for each varies. The most common reasons are:
- A very small percentage of children develop an eye turn very soon after birth (in the first 3 to 6 months). Usually this type of turn is an inward eye turn. The cause of this turn is a problem with the way the eye muscles are controlled by the brain. Usually these cases require an operation in order to straighten the eye.
- Most children develop a turned eye after age 12 months. The majority of these are the result of longsightedness. Simply stated, the child has a focus problem, which causes the secondary eye alignment problem that you can see. When your child focuses on an object, in order to see it clearly, there needs to be stimulation of the muscles around the eye, to pull the eyes in. Eventually the brain learns to adapt to this by leaving one eye in constantly and “turning it off”. This eye turn is more likely to be noticed as the child becomes more involved in close work (ages 2 to 4 years). This is because close work requires a greater focus effort to keep things clear hence the greater pull inwards of the eyes. The turn may also be precipitated by illness or fatigue again due to the fact that there is an increased effort involved in keeping the world clear under these situations. There can also be a genetic predisposition for this to occur. This type of eye turn is treated with spectacles.
- Some individuals seem to have an excessive stimulation of the inner muscles that pull the eyes inwards when the eyes try to focus. This can occur even with relatively low degrees of long-sightedness. Eventually the brain learns to leave one eye in and “turns it off” to alleviate the effort of coping with the misalignment.
Some children have a combination of the two latter conditions above. Either way it is important that you understand that rarely is an eye turn due primarily to a muscle problem.
What happens if we do nothing? Don't some kids grow out of it?
Unfortunately, a child will very rarely grow out of an eye turn. Usually exactly the opposite occurs in that the turn will get worse if left untreated. There may be times when you do notice the turn appears worse, depending on how tired the child is, how much close work they have been doing, if they are ill or upset etc. Having said that, even if the eye is turned a little the child will still be making the same adaptations to the problem. That is, the eye will still be turned off and is becoming lazy.
Even if your child's eye turns in occasionally or only by a small amount you should have their eyes thoroughly examined.
So there are three problems we must address:
- The first is the eye health
- The second is a cosmetic problem of the eye looking unsightly when it is turned
- The third is that the eye is becoming lazy
Babies sometimes look like they have a turned eye when actually the bridge of their nose is flat, giving the illusion the eye is turned. As the nose becomes more adult-like in shape, the eye no longer looks turned. In these cases, people often think that their child has grown out of having a turned eye, when in fact it was never turned.
What does my child see when the eye is turned?
The brain of a young child is very adaptable and so can make changes so that they almost see as well as a person with straight eyes. Children with a turned eye have slightly reduced ability to discriminate depth and so tend to be a bit clumsier than other children, however it does not usually affect their performance at school.
We need to remember though that they have a cosmetic problem and only one fully-functioning eye.
Because my child is only looking out of one eye, does this mean that the good eye will get worn out?
No. Looking through one eye more than the other does not wear out the good eye.
How do we straighten the eye?
We have a number of options for treating your child's turned eye. They are:
- Spectacle lenses
- Eye exercises and patching
No single approach is better than the others. The approach depends on what type of eye turn your child has. We may need to use two or even all three to get the best result.
If you go back to the most common reason for a turned eye you will appreciate that if we correct the long-sightedness with spectacles we can help straighten the turned eye. The spectacles help resolve the reasons why the eye turned. In some cases this is all that has to be done.
Another way to think of the role of spectacles in treating the eye turn is to think of them as being like braces on crooked teeth. The braces are added to help straighten the teeth and during this process they are required to be constantly tightened and adjusted as progress is made. As your child develops the ability to maintain their eyes straight, the spectacle lens powers will need to be gradually changed. It is even possible in some cases for the spectacle lenses to be totally eliminated. This depends on a number of factors including the degree of the turn as well as how long-sighted your child is.
Don't be worried about not being able to get your child to wear spectacles or how they will look. Your optometrist will be able to show you how to train your child to wear spectacles even from a very young age. No matter how unsightly you think spectacles are, an eye turn is always worse. Besides, the stigma of spectacle wear has long since abated with the "cool" frames that are now available for children. As your child gets older, using contact lenses instead of spectacles could also be considered.
Visual training (or eye exercises) can be designed to teach your child to see through the lazy eye and better control their eye alignment.
If your child has an eye turn in the first 6 months of life or a true muscle defect then surgery may be recommended.
Often only one surgical procedure is required. However some children may require a second operation. It is uncommon to require a third. If your child needs an operation the surgeon will be able to give you an idea of the chance of successfully straightening the eye after one operation.
Generally speaking, the goal of surgery is for your child to appear to have “straight” eyes. You may be required to have your child wear a patch or glasses after the surgery.
You need to be aware that surgery usually does not treat the underlying problem. But sometimes the problem cannot be found or treated. The eyes may not be perfectly straight after surgery. In some cases we have to settle for a good result rather than a perfect one.
Eye muscle surgery is reserved for those cases that are not responding well to glasses. As the results with surgery tend not to be as good as those that can be achieved with glasses (when they work), surgery should not be considered as an alternative to glasses.
Is There Anything Else I Should Know?
As progress is made, you can expect your child to demonstrate some variable eye turn behaviour. For example, you may sometimes notice that as the eye turn improves, the good eye now starts to turn. This does not mean the good eye is deteriorating but rather that the poorer eye is now as good as the good eye. Initially your child may not like their spectacles because they will change their visual world. They may feel strange or things may look funny through them. These symptoms in themselves are not bad and should be viewed as the visual system changing for the better. Either way these symptoms will be short term experiences only.
As your child improves, their spectacle correction may need to be changed. Before treatment commences it is very hard to predict how often this will occur. Sometimes bifocal lenses are also used in the treatment of the eye turn. Children do not have the adaptation problems that adults have getting used to bifocals. Nowadays many different types of bifocals have virtually invisible lines so that often neither an observer nor the child will even know they are bifocals. It will always be important that your child has regular visual examinations throughout their schooling.
Frequently Asked Questions
So, What is Behavioural Optometry?
Behavioural Optometry is many things to many people even within the profession. The common link is the understanding of vision and how to encourage its development. It tends to be more holistic in its approach as it tries to incorporate the physical, neurological and developmental aspects of vision.
How is a Behavioural Optometrist Different?
Behavioural Optometrists spend years in post-graduate and continuing education to master the complex visual programs that are prescribed to prevent or eliminate visual problems and enhance visual performance.
Not all optometrists practice Behavioural Optometry, which includes neurodevelopmental and functional optometry.
How Do I Find a Behavioural Optometrist?
Ask the Following Questions:
- Do you assess and treat children?
- Do you test their vision at the reading/writing distance?
- Will you provide a report on your findings?
- Do you offer vision therapy, or do you refer to someone who does if it is indicated?
Is Behavioural Optometry Covered by Medicare or Private Health Insurance?
Most initial consultation fees fall under the scope of Medicare. More specific services and Vision Therapy may or may not. It is essential to discuss this with your Behavioural Optometrist prior to commencing any program.