Author: Kat J. McAlpine

Ask the expert: What is the best way to correct my child’s crossed eye?

Image of Dr. David Hunter, an expert at using Botox to correct crossed eyes
Dr. David Hunter is experienced in using traditional strabismus surgery and Botox injection to correct a child’s crossed eye.

If you see that your child’s eye has become crossed, or he or she complains of having double vision, you may be struggling to find clear answers about what caused this to happen and the best way to get your child’s eyes working together again.

When the sudden onset of an inward-turning crossed eye doesn’t respond to glasses and isn’t associated with other systemic or structural disease, it’s known as acute comitant esotropia. This condition is quite rare and usually requires prompt surgical intervention.

Strabismus: Misaligned eye(s)
Esotropia: Inward-turning (“crossed”) eye(s)
Comitant: Eye misalignment stays the same throughout full range of gaze

Until recently, the only treatment for acute comitant esotropia has been traditional strabismus (misaligned eye) surgery.

But more recently, injection of medical-grade botulinum toxin (Botox) has been used to correct esotropia.

So, how do you know if Botox injection is appropriate for correcting your child’s esotropia? Dr. David Hunter, Ophthalmologist-in-Chief at Boston Children’s Hospital, answers questions about the differences between strabismus surgery and Botox injection.

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A father’s hope for his son’s life

Juan and Fredy pictured in 2017, nearly one year after Fredy's tumor was removed.
Juan and Fredy in 2017.

Juan was looking forward to having his son, Fredy, 14, finally come home to live with him. The teenager had been living under the care of his grandmother since he was a toddler.

But on that long-awaited homecoming day, Juan was quickly jarred from feeling great joy to grave concern.

“When I saw his face, one side looked very different from the other and his lip was swollen,” says Juan. “He admitted right away that his face had been hurting.”

Juan remembered that the last time he’d seen his son — more than one year ago — Fredy’s face had looked slightly different then too. But whatever was happening, the situation had clearly become much worse since then. Something was undeniably very, very wrong.

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Double take: The special approach that corrected one child’s vision overnight

Dr. David Hunter, pictured here, corrected Eliza's crossed eye at Boston Children's Hospital
Dr. David Hunter is a pioneer in detecting and treating children’s eye conditions with a range of new and tried-and-true technologies and techniques.

“At school I was seeing double today, Mom,” said 9-year-old Eliza in May of 2015. Catherine hadn’t noticed her daughter’s eyes crossing and suspected that her fourth grader was simply tired.

A few weeks later, however, Catherine and her husband were sitting in the front row at Eliza’s chorus concert, when suddenly they both noticed their daughter’s eye was crossed. It was Eliza’s 10th birthday.

“She was fine one day, and then the next her eyes weren’t working together,” says Catherine. “It was terrifying.”

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First a birthmark, then a rare-disease diagnosis

Brielle, who has Sturge-Weber syndrome, peers over a wooden fence as she plays outside
Brielle plays near her home in Rhode Island.

Two-year-old Brielle Coutu loves listening to music, dancing and eating enough cheese that her mother, Heather, often wonders aloud, “Are you a mouse?” Brielle loves to play outside and is usually a chatty, happy-go-lucky little girl. But, sometimes, she can be overwhelmed by the excitement of gathering with family and friends.

“We think she has some sensory sensitivities related to her Sturge-Weber syndrome,” says Heather.

Brielle was born with what’s known as a port-wine birthmark on her face. It is aptly named for its dark reddish color. Port-wine birthmarks can be present on otherwise healthy babies. But Heather and her husband, Justin, quickly learned that this type of birthmark can alternatively be symptomatic of a worrisome underlying condition.

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