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Dr. James
Dr. James, Board Certified Ophthalmologist
Category: Eye
Satisfied Customers: 2286
Experience:  Eye Physician and Surgeon
20222826
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My four year old has one eye higher than the other. Is this

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My four year old has one eye higher than the other. Is this normal or should we be concerned? Thanks.
Dr. James :

Hello.

Dr. James :

is it the eye or eyelid that is uneven?

Customer:

Her eye is higher.

Customer:

Her eye is higher

Dr. James :

when did this first appear?

Customer:

we went for a routine first visit to an optometrist today and he said that we should look at pictures

Customer:

to see if there have been changes it is hard to tell in the last year and we don't have access to pictures earlier right now

Customer:

he suggested it can be a sign of a tumour but that is very rare

Dr. James :

did the optometrist refer your daughter to an ophthalmologist?

Customer:

no

Customer:

we are going to re visit him tomorrow with the pictures

Dr. James :

what was the optometrist's diagnosis?

Customer:

he had no diagnosis but did indicate that rarely it is a sign of a tumour and to watch for changes

Dr. James :

misaligned eyes can occur in childen. in most cases the misaligned eyes are crossed inwards or outwards toward the ear.

Dr. James :

vertical misalignment with one eye higher or lower is is not as common.

Dr. James :

I'd recommend your child be evaluated by a pediatric ophthalmologist.

Dr. James :

you can ask for a referral from the optometrist.

Customer:

what could cause vertical misalignment?

Dr. James :

do you notice the vertical misalignment?

Customer:

I didn't until he pointed it out

Dr. James :

is it there all the time or only sometimes?

Customer:

all the time

Dr. James :

most common cause is a weakness of one of the eye muscles, (superior oblique muscle).

Customer:

In toronto, it could take quite a while to see an opthamologist so I am trying not to be

Customer:

too freaked out by the "tumour" option

Dr. James :

sudden changes in eye alignment could be due to problems with the brain, but i agree with your optometrist that this is rare.

Customer:

would a weak muscle issue be evident in pics of her at all ages or would it change

Dr. James :

it can vary, but usually present most of the time.

Dr. James :

unfortunately, pictures can be deceiving since the angles can be different with each picture.

Customer:

what steps would an opthomologist take

Dr. James :

a detail eye exam.

Dr. James :

the difference being that a pediatric ophthalmologist would have more experience.

Customer:

do you know any good paediatric opthamologists in toronto or buffalo NY?

Dr. James :

unfortunately, I do not.

Customer:

thanks for your expertise

Dr. James :

your optometrist would be the best resource for a referral.

Dr. James :

you're welcome.

Customer:

good night

Dr. James :

good night.

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