American Medical Association Family Medical Guide - American Medical Association [749]
A child can be born with misaligned eyes, but this condition usually goes away on its own by the time a child is about 6 months old. The condition can also develop during childhood, usually between ages 2 and 7, when vision is still developing and the eye muscles are unbalanced and uncoordinated. Most children who have misaligned eyes do not see double because their brain ignores what one of the eyes sees. Because one of the eyes is not being used, it will gradually weaken. If the disorder is not treated, vision in that eye will be impaired (called amblyopia).
When the eyes become misaligned after childhood, the cause is usually an underlying disease or condition that affects either the nerves that transmit information between the brain and the eye muscles or, less frequently, that affects just the eye muscles. Possible underlying causes of misaligned eyes include diabetes (see page 889), high blood pressure (see page 574), temporal arteritis (see page 927), brain injury (see page 680), multiple sclerosis (see page 696), and myasthenia gravis (see page 701).
Many children are born with a fold of skin over the inner corner of each eye that covers part of the eyeball and may make the eyes appear misaligned. Their eyes are not misaligned, however; this is simply a normal variation.
Symptoms
In children, eye misalignment can be constant, or it can come and go. In addition to uncoordinated movement of the eyes, most adults who develop misaligned eyes experience double vision and sometimes problems with depth perception. They also may have symptoms of an underlying disorder that is causing the misalignment. Any child or adult who has misaligned eyes should be evaluated by an ophthalmologist.
Diagnosis
To diagnose misaligned eyes in a child, an ophthalmologist will perform an eye examination and may order tests to determine the cause. He or she will check for abnormalities in the eyes, in the movement of the eyes, and in the muscles that control eye movement.
To determine the underlying cause of misaligned eyes in an adult, an ophthalmologist asks about the person’s symptoms and performs an eye examination. He or she may also order blood tests and a CT scan (see page 112) or MRI (see page 113). The ophthalmologist may recommend that you see your primary care doctor or a neurologist (a doctor who specializes in treating disorders of the nervous system) for further evaluation and treatment.
Treatment
Early treatment of eye misalignment improves a child’s chances for normal vision. Children whose eyes are misaligned may need to wear an eye patch over the good eye and eyeglasses to ensure use of the misaligned eye and to strengthen vision in it. Surgery to tighten or loosen some of the muscles that control eye movement is frequently performed, especially in children under age 2. The procedure is usually performed on an outpatient basis, and the child stays in the hospital for a few hours after surgery. The child may need to wear an eye patch and glasses after surgery.
If a child’s eyes become misaligned after age 2, an ophthalmologist usually prescribes glasses to correct the condition. The child may also need to wear a patch over his or her good eye for several hours each day to ensure use of the misaligned eye. In most of these children, the combination of a patch and glasses corrects the misalignment within a few years. In some children, surgery on the eye muscles may be needed to align the eyes.
In adults, successful treatment of an underlying disease or condition may eliminate the misalignment. Double vision may go away on its own within a few months. In some cases, an ophthalmologist may prescribe special glasses to correct the problem. In other cases, doctors may recommend surgery to tighten or loosen