The Difference Between Cross Eye & Lazy Eye

I’ve talked in the past that Owen’s eyes cross. Strabismus is the technical term. We have been going to Ophthalmology (world’s hardest word to spell, by the way) every 3 months because the degree of crossing has been changing. Once he has hit a stable level of crossing, then the plan is for him to have an outpatient surgery to correct it.

Last week when we went for our routine check in, we were told that Owen needs to start a patching routine. I was a little surprised because in the past, we’ve been told that patching and glasses wouldn’t help Owen’s eye crossing and that surgery would need to be his plan. So I asked if this new patch plan was in efforts to not need surgery. The answer from the Orthoptist was that surgery is for crossed eye. Patching, in Owen’s case, is for lazy eye.

Say what?!  I thought Lazy Eye was the same as crossed eyes?

So, it seems my lifelong belief that Lazy Eye and Crossed Eye were the same thing has been debunked. I know I’m not the only one who didn’t know the difference because nearly everyone I told whined to that we’d be doing patching also asked if that meant no surgery. Fortunately, Minnesota Lions Children’s Eye Clinic at Amplatz Children’s Hospital sent me home with a very handy peach brochure which helped me better understand the differences.

Strabismus (Crossed Eye or Wondering Eye) is a misalignment of the two eyes. One or both eyes can cross or drift out. In cases when vision is very poor and it’s suspected that the child is crossing his/her eyes in attempt to focus, glasses may correct strabismus. However, in most cases, eye crossing is related to how the brain gives signals to the eye muscles, not a vision issue. Therefore, muscle surgery is the recommended treatment for crossed eyes.

Amblyopia (Lazy Eye) occurs when one eye sees a blurred or different image than the other. Eventually, the brain will stop using the weaker eye and the child will lose vision in that eye. If it’s not corrected in childhood, that vision cannot be recovered, even with glasses. By patching the stronger eye, the brain is forced to use the weaker eye and the vision can be restored.

So, lazy eye and crossed eyes are very different, but here’s why you may have not realized it: Amblyopia can cause Strabismus and Strabismus can cause Amblyopia. The brain is efficient, and if it’s getting confusing information then it will adjust so it’s not longer confused. Therefore, often, if a child is treated for one eye disorder they will also be treated for the other.

Patching Tips: When we got word that Owen would need patching, I took to Facebook to get tips to make the patching process a little easier on Owen (and me). The overall consensus was distraction is key to the child not pulling it off. I’ve also read that some parents chose to put the patch on while the child is still sleeping to make application easier. What worked for us, was a tip from Early Intervention PT, Nancy. I put the adhesive patch on first and then put the elastic, pirate-style patch over the top. The pirate-style patch acts as a decoy, of sorts, and when he gets that off and still can’t see, he stopped. We did that the first 3-4 days and now he just takes the adhesive patch without too much fuss. He still cries at application, but once it’s on, he leaves it alone. I give him his electric toothbrush or jiggler during application to help keep him calm.

If you have other tips, please share. We are still new to this and I’m sure other readers are interested too.

Owen in true pirate form, I hadn't realized his leg was stuck.  Now I know why I didn't want to stay long.  This was his last time in the exersaucer before it moves on to new owners.

Owen in true pirate form, I hadn’t realized his leg was stuck. Now I know why he didn’t want to stay long. This was his last time in the exersaucer before it moves on to new owners.

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Eye and Lung Updates and Farewell Scout and Dolce

Wow, we had a busy week!  Kyle traveled for work, Grandpa Mike was up Wednesday through Sunday when he took Scout and Dolce down to their new homes, Grandpa Corky stopped by Friday, Early Intervention and Eye Check on Wednesday and Pulmonary visit on Thursday.

Eye Exam Results & Plan

Not surprisingly, the Ophthalmologist confirmed Owen’s eyes are crossed (Strabismus is the medical term).  Essentially eye crossing is caused by the brain not properly communicating with the eye muscles.  His eyes are healthy and his vision is exactly what is expected in a baby his age, so crossing is not effecting his ability to see or use his eyes.  Crossed eyes are very common in children who have PVL (the type of brain damage that Owen has) and the doctor feels confident that the injury is the root cause.

Sometimes, if a child has crossed eyes and very impaired vision, glasses may be the first tool used to try to correct eye crossing – theory is these people are crossing their eyes in effort to focus.  However, because Owen’s vision is not impaired, glasses are not in his plan.  Eye patching is sometimes used for mild cases of eye crossing.  Owen’s wouldn’t currently qualify as mild.  Therefore, the ophthalmologist suspects an eye surgery is in Owen’s future.

Typically, when an infant is diagnosed with crossed eyes, surgery is performed pretty quickly following diagnosis.  However, in children with PVL many doctors like to watch and wait before performing the surgery.  I’ll spend a lot more time explaining PVL tomorrow, but essentially PVL is associated with development delays.  Those delays also apply to the eye, so Owen’s eye crossing still may improve or worsen and they don’t want to correct until they understand where he’s going to land.  The best estimate is eye surgery in 6-12 months, but it could be as much as several years if it appears his eyes are still changing.  Our next check in with the Ophthalmologist is in September.

Pulmonary Visit Update

We also saw Owen’s Pulmonary doctor last week.  Overall the visit was positive.  Besides listening to Owen’s lungs and watching how he breathes, the best indicators of lung health to her are growth and development.  Growth, both weight and height, tells her that Owen’s body is not using up all its energy breathing.  Also, the best way to get healthier lungs is to grow taller because lungs grow as you lengthen, and this new lung tissue should be healthy tissue.  We saw last week that Owen’s had quite the development surge lately which indicates that he’s got some lung reserve beyond breathing and growing.

Now that we are back to a healthier place, the plan is to start working towards Owen doing his breathing without support.  He currently get’s both oxygen support and drug support, via diuretics.  On oxygen settings as low as Owen’s, of the two forms of support, diuretics have more potential negative side effects than the oxygen. Therefore, before trying to reduce his oxygen any further, we will first work at weaning Owen off the diuretics.  That plan means we aren’t looking at a close in plan to lose the tank and cords (boo), but by losing the diuretics, we lose three prescriptions that are each given twice a day which is a nice mid-term goal to look forward to.  It’s three prescriptions because Owen has to have some good supplements put back into his body to replace the ones the diuretics have him pee out.  The doctor wants to give a couple more weeks to let him settle out from his last hospitalization, so the plan is to start lowering his dosages in early June.  Fingers crossed!

Pet Free House

Grandpa Mike made the long drive from Springfield, IL to take Scout and Dolce to their new homes.  The house doesn’t feel the same and we are heavy-hearted.  Scout figured out something was up over the weekend and it was hard to see her so sad.  We know she’ll adjust and be well-loved, but this week, that doesn’t make it easier.  It’s not an easy decision,  but it’s worth it all in effort to give Owen healthy lungs.

PS – Thanks Grandpa Mike and Grandma Roxie for rearranging your schedules to leave a day earlier. Making a 8 AM doctor appointment at Amplatz would have been a challenge had I also had to get Kellen to school.  It was so nice for Grandpa to finally be able to visit when Owen wasn’t in either the NICU or PICU.  They had some nice bonding time and Kellen always loves Grandpa days at the Mall of America.