Stories about: strabismus

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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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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One mom’s insights: Navigating care for children with behavior differences

autism complex care

Diba Jalalzadeh, now 12, paces energetically around the waiting room. She has been coming to Boston Children’s Hospital since she was a baby. Today she is seeing her developmental medicine specialist, Dr. Carolyn Bridgemohan.

But she’s just one of the many specialists Diba sees at Children’s.“We touch on many departments,” says Monir, Diba’s mother.

Diba was diagnosed with Crouzon syndrome when she was 10 months old. She has had several surgeries to manage the effects of her craniofacial syndrome on her skull, eye muscles, tonsils and adenoids. She currently wears a brace on her chest to counter kyphosis (her shoulders’ tendency to cave in).

Though she’s never gotten really sick, Diba is a complex patient. Unrelated to her syndrome, she also meets criteria for autism spectrum disorder, so procedures most kids will put up with can potentially make her very anxious.

Blood pressure measurement? “She doesn’t enjoy that at all, but she tries to get through it.”

Sleep study? “She had a very hard time sleeping through the night but she managed to sleep a little,” says Monir. “If you ask her to do it again, she says, ‘No I can’t even try it!'”

Eye patching for an exam? “I won’t do it.” (She finally agreed to it at the end of the visit.)

Even measuring Diba’s head circumference can be a challenge.

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Our patients’ stories: Overcoming Duane syndrome

On Tuesday, June 21 at 6pm ET, Children’s Ophthalmology team will present a live, free, interactive webcast on Duane syndrome, a rare type of strabismus that causes a misalignment of the eyes. The webcast will include an overview of the eye condition and will present the case of Claire Kelly and the surgical procedures used to realign her eyes. Click here to watch the webcast, and read on for Claire’s story.

Claire Kelly before her superior rectus transposition surgery
Claire Kelly may have been born with Duane syndrome, a rare type of strabismus that causes a misalignment of the eyes, but she wasn’t aware of her condition until a less-than-subtle classmate brought it to her attention when she was 6. “One day in kindergarten this boy sat across from me at the lunch table and said ‘You’re cross- eyed,’” remembers Claire, now 9 years old and finishing up the third grade. “That’s when I first realized there was something wrong with my eyes.”

 

And while Claire may have been unaware of her Duane syndrome at first, her mother Abby recognized it almost from the beginning. Abby has a close friend who also has Duane syndrome, so she was already familiar with a few of the warning signs. When she noticed her 10-week-old daughter’s eyes weren’t as symmetrical as she thought they should be, she spoke to an ophthalmologist about early treatment.

“A doctor who specializes in Duane syndrome happens to have an office close to our home. He examined Claire and confirmed that she did in fact have it, but because she was so young he felt that treatment could wait until she was bigger,” Abby says. “So for the next few years we simply monitored her and waited to see how her eyes developed as she got older.”

But as Claire grew, her Duane syndrome became more pronounced. Then, when she was finally old enough to undergo the medical procedure that would correct her vision, Abby began to get a little nervous about potential problems that might arise post surgery.

“Because the eyes are so delicate, part of me was worried about complications from surgery,” she says. “It wasn’t until Claire came up to me and said, ‘Mom, I’m ready’ that I realized it was time. The next day we began researching eye procedures.”

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