Q. Does my baby have squint eyes?

Answered by
Dr. Pooja Bandivadekar
and medically reviewed by iCliniq medical review team.
Published on Jan 02, 2017 and last reviewed on: Oct 09, 2018

Hello doctor,

The query is regarding my 6.5 months old baby girl. She has been seen by two pediatric ophthalmologists. The first one examined her eyes using a Plusoptix vision screener and assured us that everything was normal based on the testing results. He assured us that there was no strabismus. He said that she has +2 hyperopia in both eyes, but said that is normal considering her age and it will go away on its own. The second ophthalmologist diagnosed her with accommodative esotropia after a retinoscopy exam. After dilating her pupils, he said that she has hyperopia of +5 in both eyes. I am so lost as to why she got two completely different results within two weeks apart. I need a third opinion in regard to this matter.

Dr. Pooja Bandivadekar

Ophthalmology (Eye Care)
#

Hi,

Welcome back to icliniq.com.

  • The amount of refractive error manifested depends on the cycloplegic medications used and the amount of time elapsed after using the medication.
  • The gold standard for a 2 year old is Atropine ointment for three days followed by retinoscopy. So, if different medications were used consider the atropinization results as standard.
  • Again, +4 or +5 D (diopters) refractive error is not uncommon in children of 2 years. No correction is needed unless squint or nystagmus is present.
  • Wait for three more months to get a revised diagnosis of squint.
  • Accommodative esotropia is difficult to be determined in young children who do not read. So, give some time and repeat the tests.
  • If possible post a picture of the child's eyes as well as the medication used for testing the numbers.

The Probable causes:

Hyperopia.

Regarding follow up:

Revert back with the details to an eye care ophthalmologist online.---> https://www.icliniq.com/ask-a-doctor-online/eye-care-ophthalmologist

Thank you doctor,

Your answer makes perfect sense since 4 or 5 D error is not uncommon in 2 years old children. Since my baby is only 6 months old, I cannot understand why the retinoscopy showed 5 D error and only 2 D when examined with a photoscreening device. I have attached a photo showing how my baby's eyes are most of the time. She only crosses her left eye occasionally. Please let me know your thoughts.

Dr. Pooja Bandivadekar

Ophthalmology (Eye Care)
#

Hi,

Welcome back to icliniq.com.

  • In this picture (attachment removed to protect patient identity), the child is slightly gazing to the opposite side, that is she is looking at the light reflexes.
  • As young children have small white of the eye and a proportionately larger cornea, which is normal for them, it may appear that the eye has a squint. There are a few tests like the cover test and cover-uncover test that the pediatric ophthalmologist may be using to unmask the latent esotropia.
  • The best solution is to repeat the test after two to three months. Again, small amounts of esotropia correct itself with growth and glasses, so do not worry.
  • There are few tests like Cardiff acuity test, visual acuity or preferential looking tests to quantify how much the child sees. These can also be carried out to reach a conclusive diagnosis.

For further information consult an eye care ophthalmologist online --> https://www.icliniq.com/ask-a-doctor-online/eye-care-ophthalmologist

Thank you doctor,

I have attached a better picture. I hope this one is clear for you to make a diagnosis.

Dr. Pooja Bandivadekar

Ophthalmology (Eye Care)
#

Hi,

Welcome back to icliniq.com.

  • From the picture (attachment removed to protect patient identity), it does not look like an esotropia or a squint. The eyes appear normally aligned in this photograph.
  • But, do follow up with your pediatric ophthalmologist about three months later.

For further information consult an eye care ophthalmologist online --> https://www.icliniq.com/ask-a-doctor-online/eye-care-ophthalmologist 

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