Does my baby have squint eyes?

Question

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.

Answer 1

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 two 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.

Answer 2

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.

Answer 3

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.