Turned Lazy Eyes
It is perfectly natural as a parent to feel anxious and a little upset by the fact that your child has a turned eye. You may have noticed that your child doesn’t perform certain visual and hand-eye tasks as well as expected as a result of the eye turn.
Why did my child develop a turned eye?
(a.) 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 way the eye muscles are controlled by the brain. Usually these cases require an operation in order to straighten the eye.
(b.) Most children develop a turned eye after age 12 months. The majority of these are the result of longsightedness. When your child focuses the eye on objects to see things clearly this results in stimulation of the muscles, which pull the eyes in. Eventually the brain learns to adapt to this by leaving one eye in constantly and turning it off. Often this turn is more noticed when the child is becoming 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. Again, there can also be a genetic predisposition for this to occur. This type of eye turn is treated with spectacles.
(c.) 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 longsightedness or little near work demand the eyes get excessive stimulation for an inward position. Eventually the brain learns to leave one eye in and turn it off to alleviate the effort of pulling both eyes out. Some children have a combination of both b. and c. conditions. Either way it is important that you understand that rarely is an eye turn due primarily to muscle problem. What happens if we do nothing? Don’t some kids grow out of it? Unfortunately, very rarely will a child grow out of an eye turn. Usually exactly the opposite occurs in that the turn will get worse if left untreated. There maybe 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 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 health. The second is a cosmetic problem of the eye looking unsightly when it is turned. The third is the eye is becoming lazy. 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. They have slightly reduced ability to discriminate depth and so tend to be a bit clumsier than other kids. 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.
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 is 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 not uncommon 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. There are a number of common reasons why an eye may turn. As a result the treatment for each varies.
As progress is made we will expect your child to demonstrate some variable eye and head turn behavior.
Sometimes bifocal lenses are also often used in the treatment of the eye turn. Children do not have the adaptation problems that adults have getting used to bifocals.
We hope this information has helped you understand what needs to be done and why. Today we can successfully treat most eye turns. We will need your help at home. You child may need to wear glasses or a patch, or do exercises and you will need to help us with this. We are here to help and support in any way we can so don’t hesitate to call your behavioural optometrist if you are having problems or have other questions.
Treatment Options: 1. Spectacles
If you go back to the most common reason for a turned eye you will appreciate that if we correct the longsightedness with spectacles we can help straighten the turned eye. The spectacles help remove the reasons why the eye turned. In some cases this is all that has to be done.
As your child gets older wearing contact lenses instead of spectacles is a possibility
Treatment Options: 2. Eye exercises
Visual training (or eye exercises) is designed to teach your child to see through the lazy eye and better control their eye alignment.
Treatment Options: 3. Surgery
If your child has an eye turn in the first 6 months of life or a true muscle defect then surgery may be recommended. Generally speaking, the goal of surgery is to get your child looking normal.