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My 2.5 year old daughter's eyes drift outward and upward,

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my 2.5 year old daughter's...

my 2.5 year old daughter's eyes drift outward and upward, when she's tired or in motion (car ride, dancing, swinging, etc.). this used to occur infrequently (a few times a month), but over the last week, it's been happening 2-4 times a day. we saw a neurologist who said that her eye movement is benign and is something similar to Bell's phenomenon. then we saw an eye doctor who said it was abnormal, but didn't give us any explanation as to why. she did mention that our daughter's eyes are anatomically perfect, but that her left eye deviates a little from her right eye (near-nearsightedness), but did not prescribe glasses at this time. This eye roll lasts less than half a second, but is disheartening to watch :(. What can this be? Could this be exotropia‏?

Submitted: 4 years ago.Category: Eye
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Answered in 4 minutes by:
3/5/2013
Eye Doctor: Dr. Dan B., Board Certified Ophthalmologist replied 4 years ago
Dr. Dan B.
Dr. Dan B., Board Certified Ophthalmologist
Category: Eye
Satisfied Customers: 3,343
Experience: Eye surgeon experienced in cataracts, glaucoma, retina & neuro-ophthalmology
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Doctor DanB :

Hello and thanks for your question. Yes, what you are describing sounds like exotropia, but also with some hypertropic movements associated with it, which is not an uncommon association with exotropia. Ironically, even though she may see fine and not "need" glasses from a vision standpoint, some nearsighted glasses may actually help to control the drifting out of her eyes. Does that make sense?

Customer:

yes, it makes sense. my husband was just on the phone with our daughter's pediatrician who said that because both of her eyes drift together, in the same direction, it's unlikely that it's exotropia, but she's not an eye doctor. in your experience, can both eyes drift in the same direction with this condition?

Doctor DanB :

Ah, I see, so both are drifting in the same direction... Then, that does not sound like exotropia. Was the eye doctor you saw an optometrist or an ophthalmologist?

Customer:

pediatric ophthalmologist

Customer:

she didn't see this during an exam. it's intermittent

Customer:

and happens only when our daughter is very tired or in motion

Customer:

our daughter did have a normal MRI (done a year ago). she's a very sick little girl (born with small lungs) and spent the first two years of her life at the hospital. she's neurologically normal though and even though she's a little delayed, she's catching up quickly to her twin brother and is walking and is very busy...

Doctor DanB :

Hmmm... A pediatric ophthalmologist, is the authority on exotropias and strabismus in general; however, if they didn't see it happen, then it's hard to state unequivocally that this is or isn't strabismus. When a person is dancing, swinging, or otherwise involved in movements that get the head in significant motion with respect to the environment, the eyes are constantly at work to maintain fixation and therefore help maintain balance and control of the environment, so it's not hard to see a child doing this in those circumstances. Also, however...

Doctor DanB :

I've seen many children who make these types of movements with their eyes as a means of making the eyes "feel" better. What I mean by this is it is very common for children to have dry and/or irritated eyes, the symptoms of which are often helped by blinking or sometimes, rolling the eyes underneath the eyelids (why some kids blink and some roll the eyes up or down is not always known, but I think it is a preference). With a normal MRI, a neurologist and a pediatric ophthalmologist on board who have said they don't see anything wrong, then my money would be on this phenomenon. In that respect...

Doctor DanB :

I think the best thing to do would be to start using cool compresses 2-3x/day on the eyes, as well as using artificial tears 3-4x/day in each eye and do so consistently, evey day, for 3-4 weeks. If there is surface irritation of the eyes and/or dry eyes, this is going to help and may bring an end to or cut down on those behaviors.

Customer:

the pediatric ophthalmologist did say that it was not a normal eye movement, but didn't have an explanation as to why :(. we are so confused and concerned.

Doctor DanB :

Also, if she complains of itching or rubs the eyes a fair amount, there may be some allergies involved (very common in children); in that case, the cool compresses and the artificial tears are also going to help, but she may also respond to an OTC allergy drop such as Alaway or Zaditor.

Customer:

i don't this that this is allergy related, to be honest. she started doing the eye drifting in July 2012, but she used to do this a few times a month, now she's doing this daily

Customer:

i am just concerned about the frequency... and i don't know who else to turn to... the neurologist said that from watching a video of her doing the eye movement it didn't look abnormal to him. i wish i was satisfied with that answer

Doctor DanB :

While it may not be allergy related, even subtle allergies can contribute to a dry, irritated ocular surface. I can understand your concern. Those movements are not "normal." My children don't make those movements, nor do most of my patients who are children make those movements. However, I've seen several children as patients who do make similar movements and in most who have received neurological workups (to include a neurologist evaluation and MRI of the head), nearly all of them have no identified neurological cause. That's not to say that it's normal still, but things that are life- or development-threatening can be ruled out. I still think...

Doctor DanB :

I still think that by far the most likely cause is dry eyes/irritation. However, as a parent, I also wouldn't want any stone unturned. In that respect, I think a very logical course of action would be to start using the cool compresses and artificial tears right now as I've directed, but also to take her to a neuro-ophthalmologist, who is the expert on seeing atypical eye problems such as this. Those specialists are hard-wired to find the most esoteric and difficult of problems. If you end up seeing all three types of specialists and still don't find anything wrong, then I think you have a lot more reason to try wait this out. Does that make sense?

Customer:

are you an ophthalmologist as well?

Customer:

and also, do you know of Bell's phenomenon and how it manifests itself?

Doctor DanB :

I know this probably isn't the advice you're looking for; as a parent of small kids myself, I would hope for and want a list of the three most likely things this could be and how to assess for each, or at least to be told that these are or aren't likely. But unfortunately, not having had a chance to examine her and see for myself, it would be almost impossible to offer such specifics on what is certainly a strange eye movement that does not seem consistent with any known pathology based on the way you've described it. And yes, I am a board-certified ophthalmologist with a fair amount of experience with neuro-ophthalmic disorders (though I am not a fellowship trained neuro-ophthalmologist). Yes, Bell's phenomenon is when the eyes drift upwards upon the closing of the eyes such as during sleep or at other times when the eyes are closed,. It is a normal reaction.

Doctor DanB :

I'm sorry. I must step away from my computer for about 5-7 minutes. I promise I will be right back to continue this. Please bear with me. If however, you feel this interaction has been helpful and you don't have any more questions to discuss...

Your feedback is important to me and will help me improve my encounter with future customers. Please rate your encounter with me by providing positive feedback (by pressing the smiley face); any positive feedback and/or bonus you may feel prompted to provide would be welcomed and is appreciated. If you feel like your concerns are not resolved or you have a problem or issue with anything I have said or haven’t said, please don’t issue a negative feedback rating—My goal is your satisfaction and I would rather work together to solve your concerns, until you are satisfied, than have you leave our encounter unhappy and unsatisfied.

My opinion is solely informative and does not constitute a formal medical opinion or recommendation. For a formal medical opinion and/or recommendation you must see an eye doctor. Thanks for your inquiry!

Doctor DanB :

I'm sorry; it'll still be another 10 minutes. I apologize, but I will be back.

Doctor DanB :

Again, I apologize. I am able to be at my desk for a little while longer if you have further questions, comments, or concerns.

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