Don’t roll your eyes at strabismus (lazy eye)

My patient looked up at me.  “Do you want to see what I can do?” she asked.

Her father mockingly moaned, ”Oh, no.”

“Pleeease,” persisted the girl, “just once.”

The dad just laughed.

“Watch,” she said proudly as she suddenly rolled her eyeballs back and flipped her eyelids inside out with her fingers.

“Very impressive,” I told her, and snapped a photo.


Voluntary eye movements like the one in the photo may be ugly to look at but are not damaging.  Nor will the child’s eyes be forever stuck in that position. On the other hand, any involuntary eye movement should be investigated. 

In particular, be vigilant for lazy eye (strabismus).  In this condition, the eyes are do not align correctly and drift. According to the most recent edition of Nelson Textbook of Pediatrics, lazy eye affects about four percent of children under six years of age and can manifest itself in infancy.


By two months old, your child’s eyes should be able to fix on your face and move together as she watches you. If you notice her eyes cross beyond this age, take her to her doctor. Lazy eyes tend to run in families. The child pictured immediately here has several relatives with lazy eyes. 


The cause of most lazy eye is unclear; however some cases are due to a defect in the pathways of the brain and nerves which control eye movement. Occasionally, some types are associated with other medical problems.


Detection of a lazy eye is important because a “lazy” eye can lose vision (amblyopia) from underuse. Treatment for most kids involves covering the good eye and forcing the lazy eye to “do more work” in order to prevent amblyopia. Ophthalmologists (eye surgeons) use techniques such as covering an eye with a patch, prescribing special glasses, or using eye drops to encourage the use of the lazy eye.  For some, surgery is needed to fully align the eyes. The earlier treatment starts, the more rapid the response.  Unfortunately, after a child is eight years old, treatment is much less effective.


Shortly after the girl showed me her eye rolling talent, a boy in the office showed me another intriguing trick.  By inhaling deeply, the boy sucked in one nostril until it flattened without pulling in the other one.  

Didn’t take a picture of that one.


Naline Lai, MD with Julie Kardos, MD

©2010 Two Peds in a Pod

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