Lazy or Turned Eyes
When your child has been diagnosed with a ‘lazy’ or ‘turned’ eye, it can be quite upsetting. There may be concerns about the cosmetic appearance, vision, depth perception and difficulties with hand-eye co-ordination. Determining the best treatment plan such as the need for glasses, vision therapy or surgery can also be overwhelming.
Strabismus (turned eye)
Firstly, relax! The turned eye doesn’t cause any great distress to your child. There is no pain, nor discomfort and they are often unaware of the turn at all.
This is because when the eye is turned, the brain does not pay any attention to it. This is a clever way to avoid seeing double vision or having blurry vision.
When a turn is first developing, the child may experience moments of double or blurry vision, but their brain learns very quickly to turn one of the pictures off. This is called suppression and if it occurs long enough, then the eye that’s being turned off won’t see well at all.
Amblyopia (lazy eye)
When the eyesight becomes poor from prolonged suppression, this is now termed ‘Lazy eye’ (Amblyopia) and this will need treatment to teach the brain to pay attention to the eye. Even when the correct prescription is given, the brain may continue to ignore that eye due to the habits it has created.
Sometimes, amblyopia will develop without an eye turn. Again, the brain is trying not to pay attention to an eye because it is too blurry. In these cases, the treatment is very similar to the treatment for Strabismus.
It is possible that your child will not experience good depth perception, or 3-D vision until the brain has been taught to pay attention to both eyes at the same time.
How did this happen?
Firstly, it was not your fault and secondly, there are many reasons. Depending on the cause, the treatment can be varied. See some of the options here:
Some children develop an eye turn shortly after birth and may need an operation to straighten the eye to preserve equal sight. This is typically in children aged 3 to 6 months.
Many eye turns are noticed after the age of 12 months. The cause of this is often long-sightedness(hyperopia) where the child has a focusing problem. The turn is more likely to be noticed as the child becomes more involved in close work (aged 2-4 years). Sometimes it is triggered by illness or fatigue or there may be a family history of turned or lazy eye. Initial treatment is usually with glasses.
In this case it is important to understand that there is not a problem with the muscles of the eyes, rather there is an adaptation being made in the brain. Therefore, treatment will need to address the eyeballs, as well as the brain adaptations.
Can my child grow out of it?
Unfortunately, no. In fact, the amount of turn and the intensity of the suppression will often become worse over time without treatment. Even if you child’s eye turns only sometimes, or only a little, then their eyes should still be examined and treated comprehensively.
The only exception to this is the condition called Epi-canthal folds. This is when the bridge of the nose is quite flat, or developing slightly unevenly and will often give the appearance of a turned eye. But in fact, the eye is not turned at all, it is simply an illusion. As the nose grows, the eyes will no longer appear turned. Often children are mistaken for having ‘grown out’ of a turned eye, when in fact it never existed at all.
What are our treatment options?
There are many choices available to you
- Traditional patching and eye exercises
- VIVID Virtual Reality Training
No single treatment is better than other, and often a customised combination of the above is required.
Since the most common reason for a turned eye is the troubles focusing, it makes sense that if we reduce the focusing effort, then this will allow the eye to straighten. However, when removing the glasses, the eye may turn again, or may turn more as the brain attempt to ignore the eye again. In many cases, glasses are required long-term for good binocular (or two-eyed) vision.
Often as the brain and child adapts to the prescription, it will need to be increased. These changes usually occur in the first 12-18 months and it can be hard to predict the frequency or amount of change beforehand. This is not because the eyes are becoming weaker, but because the glasses are helping the brain to overcome the need to ignore one eye. Over the years, and with the correct therapy, the prescription may be able to be reduced in children with small amounts of turn and small amounts of prescription.
Bifocals are often prescribed for turned eyes. This is because the demand on the eyes for close tasks, such as reading, writing, drawing, playing, is much greater than the demand on the eyes for far tasks. The extra support of the bifocal will again encourage the brain to use both eyes and not ignore one.
If you have concerns about your child’s ability or willingness to wear glasses, please speak to your optometrist. They can guide you in selecting modern, fashionable frames which fit well and alleviate any concerns you have about your child’s appearance. Once your child is old enough, contact lenses may become an option for them.
Customised programs including patching, eye tracking and eye control therapy are available at our practice. Often 6-9 months of therapy is required to treat turned and lazy eyes. More information can be found here. http://raoptometrists.com.au/vision-therapy/
Latest technology for developing 3-D vision in children and adults is now available for you at RA Optometrists.
This is necessary when your child is very young, or if there is a true muscle defect. In many cases, more than one operation is required, but your surgeon will carefully go over all the risks and benefits with you.
It is important to know that surgery will aim to straighten the eyes. But this does not address the underlying cause, and therefore glasses and vision therapy are likely to be needed as well.