Little Girl's Eyes

Little Girl is looking at eye surgery. Guess that's kind of a play on words . . .

She's had glasses for over 3 1/2 years now for Strabismus. There are several types of Strabismus (inward turning of the eyes). Little Girl's has to do with looking at things up close. However, she has a rare occurrence in that usually Strabismus is accompanied by far-sightedness. Little Girl is nearsighted - like both parents.

People ask all the time - how did we know she needed glasses? We didn't. We just noticed that at age 3 (picture), she was still crossing her eyes at times. We asked the pediatrician if this was normal. He didn't seem worried about it, but as he looked again he suggested a trip to the ophthalmologist would be a good safeguard to rule anything out. Our first pediatric ophthalmologist reminded me of the "dry-eye" guy on the TV commercials. Surrounded by all 4 kids(we had been at the office for an hour & a half - ages 3, 4, 7 & 8 - so you can imagine their exhausted impatience by this time) , I sat stunned as I listened to him talk about the "lenses we would be putting Little Girl in . . .", I couldn't take it in that my little 3 year old might be wearing glasses until she was 9 or 10. Of course, with the nearsighted diagnosis, I knew that this was actually the beginning of her life with corrective lenses - no matter when she outgrew the Strabismus. After seeing Dr. Dry Eyes, we scheduled our follow up appointment with a different doctor with a tad more personality (emphasis on tad), purchased our first pair of $300 (gulp!) glasses and promptly added eye insurance to our list of things to do! We've had monthly "tear the house up" moments when the glasses have been "lost" only to find them in a pocket somewhere, but for the most part she's done pretty well with wearing the glasses. Since they help her see far away as well as help her from crossing up close, she has 2 visual reasons to benefit from them.

Accommodative Esotropia-If excessive inward turning of an eye is first noted around 2 years of age, it may be due to difficulty integrating the focusing (accommodative) system with the eye alignment (binocular) system. Normally when we look across the room or beyond, our eyes are parallel, or straight. However, when we look at things up close, two things happen. We need to converge more (aim both eyes inward at the same time) and we have to input more focus, or accommodate to keep things clear. Children have large amounts of focusing power, and sometimes in getting things clear, inward turning or esotropia results. If the inward turning only occurs up close, as when playing with small objects, making eye contact, coloring, looking at picture books and so forth, the child may just need glasses for near activities to reduce or eliminate the esotropia. (webpage source)

(ASIDE: The "focusing" description above is interesting to me, because of the 4 kids, Little Girl has the most "focus" for any task at hand... I know they're two different types of "focus", but that just struck me as funny.)

So, about 6 months ago, Dr. A-Little-More-Personality had some additional concerns about her eyes. The Strabismus was doing ok, but he found concern with one effect of Strabismus.

Hypertropia implies that one eye is deviated upward relative to the opposite eye. Hypertropia may occur with other types of strabismus (which she has), or may occur in isolation. If the condition appears relatively permanent, strabismus surgery may be completed in attempt to better align the eyes. Many different procedures may be utilized for hypertropia conditions, the most common being weakening procedures of the antagonist (of the affected) muscle, and transposition procedures (surgery), whereby other muscles are repositioned on the eye to provide motility into the paralytic field of gaze. (webpage source)

She has developed Hypertropia in her right eye. He says that there is no rush on the surgery and we can wait until it's convenient for us. The procedure takes about 10 minutes and there is little to no recovery except her eye will be bloodshot for a few days. She does have to be put under. However, the doctor says if you have to have eye surgery, this is the one to have. It fixes the problem and no additional surgery is needed. It won't fix the Strabismus, but it will fix the Hypertropia which will help the Strabismus. We're still in bifocals for a while longer. It's amazing how those lenses keep her eyes from crossing.

Before Christmas, the nurse at school sent a note home saying Little Girl didn't pass her eye exam at school. We weren't due to see the eye doctor for a few more months, but since she needed to have the paperwork signed by the doctor, we went ahead and scheduled another visit to check her eyes again. Dad went with us this time since we needed to discuss the Hypertropia surgery again. Little Girl started in on her exam and I new immediately that her prescription had changed. She couldn't read any of the letters on the screen! It was obvious that her nearsightedness had gotten worse. After further discussion with the doctor, he determined that her nearsightedness and strabismus were actually working against each other. It was decided that it was time for Strabismus surgery. That coupled with the Hypertropia surgery as well would entail a 20 minute outpatient procedure with dissolvable sutures. He said they do a lot of those procedures on Fridays just to give the weekend to rest, but that other than bloodshot eyes, there is little to no "recovery" from the surgery. He suggested doing the procedure sometime in the next 3 months. And after the surgery, there would be a 95% probability that Little Girl could have glasses without the bifocals. She was concerned about "surgery", but the prospect of getting rid of the "lines" across her glasses was good news for her.

So, we're off for a 2nd opinion to another Pediatric Ophthalmologist in Dallas to see what his take on the matter is. Eye surgery is a scary thing, so we want to be sure we've got a majority vote before going under the knife. We'll keep you posted on how the outcome and decision pan out.

One note about Strabismus -you may not see any crossing at all. It's more in the way the light hits both eyes the same. It appears that Bear has a tiny bit of Strabismus. (Per her regular eye doctor.) She'll be seeing Dr. A-Little-More-Personality soon, just for a thorough exam . . .