Intermittent lazy eye in toddler
November 5, 2018 3:53 AM   Subscribe

My daughter (2.5) has an intermittent lazy eye. The eye doctor can't see it. Now what?

My daughter has an intermittent lazy eye. It's not that obvious, but if you spend enough time with her, you can see her left eye drift ever so slightly every so often. I have noticed it for a long time, and it's only this past summer that my husband noticed, as well as our babysitter, my mom and her speech therapist (all of whom saw it without me saying anything.) My dad has a fairly prominent (though also intermittent and still fairly mild) lazy eye -- same eye, same problem.

I had always thought that this should be taken care of ASAP. I finally got a referral to an ophthalmologist from my GP. When my husband took her, the doctor couldn't see it (not really surprising in a short appointment) and my daughter's eyesight came out as perfect. Doctor looked at her eyes with drops and thought they were normal. She gave us another appointment for six months. It wasn't that the doctor didn't believe us -- it's just that she couldn't see it herself (so presumably was reluctant to diagnose and/or treat it.)

I mean -- that's great, I'm glad her eyesight is good. But I'm not convinced it will go away on its own (given my dad's eye), and since the doctor (not sure actually if it was a doctor, or optician, but probably doesn't matter) can't see it, I'm not quite sure what to do now.

Is just waiting until the next appointment OK? Should I try some vision tracking exercises? (How?) Get a second opinion (possible, but expensive in the UK.) You are not my daughter's doctor, obviously, but I would love any one else's thoughts/experience on this.

Thanks so much!
posted by heavenknows to Health & Fitness (10 answers total)
Try to get a video of it to show to the doc.
posted by flibbertigibbet at 4:19 AM on November 5, 2018 [20 favorites]

I would see another doctor. As mentioned above, a video may be a good idea. My husband had this issue as a child and it tended to get worse when he was tired. Is there a trigger for your daughter?
posted by jraz at 4:54 AM on November 5, 2018 [4 favorites]

Take a photo of her with a flash. One eye will reflect and the other won't. That's how we first discovered my daughter's amblyopia/strabismus. She was 6mo old at the time. She's going to be 16yo in a few weeks.

Do you know if they used a prism to check your daughter's eyes? It kind of looks like a long angled piece of plastic that is thin on one end and gets substantially thicker at the other. With the prism, they are able to determine if she is focusing properly.

Usually, the first step is patching the 'good' eye to strengthen the weaker one before anything else is tried. My daughter wore a patch for several hours a day (you start for an hour and work your way up) for a couple months before she had her first of several surgeries. She had a pretty significant issue with one eye turning in (although they do surgery on both eyes for a better alignment). As she grew older, she needed more surgery to accommodate her eye muscles changing -- we knew this would be a probability going in. Ultimately, she had three operations in total. She does wear glasses, but not a strong script (honestly, the entire family wears them). One eye does ever so slightly align incorrectly, especially when she's tired, and it's more obvious when she's not wearing glasses and tries contacts. Any further surgery would be for purely cosmetic reasons.

One interesting result is that she doesn't have binocular vision. She sees out of one eye at a time. I believe it's one for near vision and the other for distance. The ophthalmologist said that sometimes the brain has the ability to relearn this task when the kid is really young, other times, it's already wired itself to compensate. She will be able to drive, but not fly a plane. Fine with me that she's not eligible to join the armed services - she wants to be an illustrator, anyway! Also, her prescription has consistently *decreased* for the past three or four years, which means that her eyes are having to compensate less and less.

If you can get an appointment sooner (even if it is by three months), I would do it. They grow so fast at that age, and as I mentioned, binocular vision may be a significant risk if she chooses to use one eye over the other. Best of luck with her and good on you for following through on this.

FWIW, I'm in the US and her doctor is the head of ophthalmology at Children's Hospital of Philadelphia, it's consistently rated #1 or 2 in the US (competing with Boston).
posted by dancinglamb at 4:56 AM on November 5, 2018 [7 favorites]

I don’t think 6 months is all that long for this kind of thing. They didn’t tell you to ignore it forever, you are taking action, which is to look again in 6 months.

In addition to trying to catch it on video, you can take notes. Do you see it every day or only every week? Is it more often in morning or night? When she’s wound up or tired? This kind of info will help your doctor determine what is best for your daughter at your next appointment.
posted by SaltySalticid at 5:35 AM on November 5, 2018 [3 favorites]

My brother had lazy eye, but they didn't catch it until he was four or five. However, they caught it early enough that he didn't need surgery; just the eyepatches dancinglamb mentions above, which he wore all day every day for about two or three years. Then he just wore glasses with plain glass in the good eye and a prescription in the weaker eye, then graduated to a weaker prescription in that eye, then a single contact lens in that eye, and I think by the time he was in college he didn't need anything any more.

So maybe watch-and-wait for a two-year-old isn't a bad idea. If it's intermittent, that sounds like it's mild. A video's not a bad idea either. (And if you do have to go with eyepatches, I have a comment here where I talk about something my Dad did to make the patches more appealing for my brother.)
posted by EmpressCallipygos at 6:41 AM on November 5, 2018

We took our (older - 6) kid for an eye test at an optician (Vision Express, where we get our own glasses & have had good service). They mentioned that the glasses my kid would get would help prevent a lazy eye occurring*. The NHS website also says "Lazy eye is often diagnosed during routine eye tests before parents realise there's a problem", so maybe take your kid to a high street optician to have an eye test as a second opinion. Those are free under the NHS while the child is under 16.

*The NHS site says "If there's a refractive error, it will first be corrected using glasses to correct the focus of the eye, which often helps correct a squint as well" so I assume this was the issue.
posted by EndsOfInvention at 6:45 AM on November 5, 2018

I had this as a kid – it’s called intermittent strabismus – and it’s not the same as amblyopia, which is what is usually meant by “lazy eye.” It can cause amblyopia, which is when the brain starts ignoring input from one eye, but doesn’t necessarily if her eyes are straight more often than misaligned. I wasn’t diagnosed until I was 8, and vision therapy almost completely fixed it (it only happens a tiny bit if I’m very tired). My sister had amblyopia, but not strabismus, and it was fixed when she was around the same age by wearing an eye patch.

I would probably feel comfortable waiting until my daughter was 3 for a second evaluation, although I would probably go for a second opinion with a specialist at that point if the standard appointment is the same as the first. I would not try doing vision therapy on my own – it seems like there are ways that could backfire. You should try to capture it on video before her next appointment, though. One way eye doctors would test to see my strabismus was to rapidly cover one eye and then the other several times – even now I can’t keep my eyes aligned if I do that. That trick might help you capture it, either on video or at the actual appointment.
posted by Kriesa at 8:16 AM on November 5, 2018 [3 favorites]

IANAD but I am the parent of a 5yr old with amblyopia (diagnosed at 9 months, we have 3 surgeries and a whole lot of patching under our belt). I would try to get a 2nd opinion, ideally from a pediatric ophthalmologist if your 1st dr wasn't, and try to take a picture or video as mentioned above. For my daughter her crossing is always the worse when she's tired, we would make a lot of observations during bath time. Sometimes it can be hard to detect during the appt, even with a severe case like ours, our dr has often brought in another dr to consult/verify what she'sseeing during our appt.

6 months isn't a ton of time for these things, often our plan of cycle would be 'patch for 4 months, eval and then schedule surgery for x months out', there is a lot of 'wait and see if they brain and eye can develop to work together'. Personally I would try to get that 2nd opinion now so if it does seem like your daughter has an issue you can get started on a protocol to try and correct it. Good luck!
posted by snowymorninblues at 8:21 AM on November 5, 2018 [2 favorites]

I would not worry about this timeframe. I had strabismus - in both eyes, no less! - and wasn't even diagnosed until I was 4, then did patching for 2 years, and then surgery at age 6. (And then some more patching to address a mild overcorrection....) My binocular vision is fine, etc. (I have myopia, but that's entirely unrelated.)

Very small children can often appear to have strabismus when they don't, so doctors will take a conservative approach until it is clear that there is, in fact, an issue. It sounds like the doctor isn't dismissing your concerns, she just wants to wait another 6 months and see what happens.

Nthing the recommendations to get a video if you can and keep the follow-up visit.
posted by devinemissk at 9:33 AM on November 6, 2018

My kid has intermittent strabismus in both eyes, and in his case the doctor is able to cause it to happen in office by covering one eye briefly and having him focus and then removing the eye cover. Did the doctor try to induce the strabismus? My son saw 2 optometrists and an ophthalmologist, and all were able to induce the strabismus pretty easily, even though it was fairly infrequent in his everyday life.

For our son, the problem is mild enough that he does eye exercises at home -- watching a video partially covered with a red transparency sheet while wearing glasses with one red eye and one green eye.

I would probably push about having some eye exercises like this, but would not think your kid is going to miss a window for surgery or something (I don't think you will want surgery for as infrequent as the issue sounds).

Memail me if you want more info.
posted by freezer cake at 10:09 AM on November 12, 2018

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