It is a common observation for parents to notice their newborn’s eyes appearing to cross or wander independently. This can naturally lead to questions and some concern. While it might seem unusual, this phenomenon is often a normal and temporary part of a baby’s early visual development.
How Newborn Eyes Develop
A newborn’s visual system develops significantly after birth. Eye muscles are not yet fully coordinated or strengthened. For the first two months, a baby’s eyes may not work in unison, leading to occasional crossing or drifting outwards. This temporary misalignment occurs as the infant’s brain and eye muscles learn to coordinate movements and focus.
Binocular vision, which allows both eyes to work together for a single, three-dimensional image, is a gradual process. Infants can detect changes in brightness and track moving objects from birth, but their ability to focus and fuse images improves over time. Adult-like binocular vision emerges between 12 and 16 weeks of age. By 3 to 5 months, infants develop stereopsis, the ability to perceive depth from slightly different views.
When to Seek Medical Advice
While temporary eye crossing is common, there are specific signs that indicate a medical consultation is warranted. If a baby’s eyes continue to cross or wander consistently after 4 to 6 months of age, this is a concern. Persistent inward crossing after three months or outward drifting after four months warrants referral to a pediatric ophthalmologist. This continued misalignment, known as strabismus, does not resolve on its own.
Other signs for medical evaluation include constant misalignment in one or both eyes, or if the eye turn occurs for more than a few seconds. Parents should also look for a white spot in the pupil, excessive tearing, extreme sensitivity to light, or if the baby cannot make steady eye contact or follow objects by three months. Early detection and intervention are important to prevent long-term vision issues.
Common Causes of Persistent Misalignment
When eye misalignment persists beyond normal development, it can be attributed to medical conditions. Strabismus is the medical term for misaligned eyes, where one eye may turn inward (esotropia), outward (exotropia), upward (hypertropia), or downward (hypotropia). It affects 2 to 4 percent of children and can be constant or intermittent. Infantile esotropia, characterized by significant inward turning of both eyes, can develop within the first six months.
Another condition associated with persistent misalignment is amblyopia, also known as “lazy eye.” Amblyopia occurs when the brain favors one eye, leading to reduced vision in the ignored eye. This can happen if eyes are misaligned, causing the brain to suppress the image from the turned eye to avoid double vision. Conditions like significant farsightedness (hyperopia) or an anatomical problem such as a droopy eyelid or cataract can also lead to amblyopia.
Diagnosis and Treatment Approaches
Diagnosing persistent eye misalignment involves a comprehensive eye examination by an eye care professional. Pediatric ophthalmologists use various tests to evaluate eye alignment and vision, even in infants who cannot communicate verbally. These tests may include evaluating the light reflex, using prisms to analyze alignment, or assessing the child’s ability to fixate on and follow a moving object. Dilating eye drops are often used during the examination for a thorough assessment.
Treatment for persistent eye misalignment depends on the cause and severity. Corrective eyewear, such as glasses, can address refractive errors like farsightedness that contribute to misalignment. Patching therapy involves covering the stronger eye for several hours daily to encourage the weaker, misaligned eye to work harder and develop better vision.
Atropine eye drops can also be used in the stronger eye to temporarily blur its vision, serving a similar purpose. In some cases, eye muscle surgery may be recommended to physically realign the eyes, especially for infantile esotropia. Early and consistent treatment is important to improve visual outcomes and promote binocular vision.