One of the major concerns of parents is whether their baby's eyes are developing normally and have good vision. During the first few months of life many infants will have eyes which are not aligned and may drift in or out at different times. Usually this misalignment only lasts for a few minutes. By age 4 or 5 months most children's eyes are straight and they are focusing well on objects and faces.

Many parents are concerned because their infants appear cross-eyed. This is most often caused by the normally wide bridge of the nose in an infant. which makes the eye look crossed. Prominent lid folds (epicanthal folds) can cover the white area on the inside of the eye and make that eye look crossed, especially when the child looks to the side. This appearance of crossing caused by a wide bridge of the nose (telecanthus) is called PSEUDOSTRABISMUS (false strabismus or misalignment). This facial appearance of crossing often improves with age and growth of the bridge of the nose.

What is the Purpose of the Home Screening Test?

To test your infant or child for possible strabismus (misalignment of the eyes) at home.

How is the Test Performed?

1) Sit with your infant or child facing you directly.

2) Hold a small flashlight just below your nose, about 2 feet from your child's face, and shine the light into both eyes (point the light between the eyes.) Your child should be looking directly at the light.

3) Observe the small white, light reflection (reflex) in the pupil (the dark area in the center of the colored part of the eye).

4) The light reflex should be centered in the pupil (or just a slight bit off center toward the nose) in each eye.

5) If the light reflex is centered in one eye and off-center in the other, this may indicate a strabismus or misalignment in one eye. Note if the off-center light reflex is on the colored or white part of the eye. Note for your doctor if the eye is crossed in, out, up or down.

6) Some infants have a wide bridge of the nose which makes the eye look crossed, especially when the child looks to the side. The wide bridge of the nose can cover the white area on the inside of the eye and make that eye look crossed. This facial appearance of crossing can improve with age and growth of the bridge of the nose. Use the light reflex test to tell the difference between this "false strabismus" and real crossing of the eyes. The light reflex test is normal in "false strabismus".

What Should You Do if You Feel Your Child Has Strabismus?

If you have any concern about whether your child has strabismus, ask your doctor to examine your child. Real crossing of the eyes in children is not outgrown.

To avoid seeing double, a child whose eyes are really crossed will use only one eye at a time. The unused or crossed eye may never develop good vision unless the child is forced to use it, usually by patching of the good eye under the direction of your ophthalmologist.

How Can You Test Vision in Children?

You can test an older child for poor vision in one eye (amblyopia) using reading charts. A Home Eye Test for Children (age range 2 and up) can be obtained free of charge by writing the National Society to Prevent Blindness.

What Are Warning Signs of Vision or Eye Problems in Children?

Warning signs that may indicate a vision, eye or strabismus problem in your child are:

  • Eyes crossed-this would include eyes turning either inward or outward or up or down.
  • Tilting the head or looking to one side.
  • Holding books very close for reading.
  • Jittery eye movements (shimmering)
  • Reddened eyes, encrusted lids or frequent styes.
  • Frequent rubbing of the eyes
  • Continual scowling, frowning or squinting
  • Frequent or severe headaches
  • Burning or itching or watering of the eyes

If you have any questions, contact Dr. Fierson.