Strabismus and Developmental Delays

Question of the Week

A child with strabismus and amblyopia.
Talk to your pediatrician if your child's eyes cross. Photo by Getty Images

Q. My 27 month old boy was slightly delayed in walking, and is currently just beginning to talk. We have had him examined by physical therapists and speech therapists, and both agreed that while he is a bit behind, things are progressing. He also has a slight "wandering eye" in which at times he becomes cross-eyed. My wife has taken him to a pediatric ophthalmologist and they have told us that he is farsighted, and the left eye is over compensating, therefore he needs glasses to correct this immediately. The doctor also asked about his delays in walking and talking in combination with his eyesight, and suggested that he be examined for a disorder as this sometimes occurs when all these issues are present. What exact condition is the doctor referring to? How serious? He mentioned a CT or MRI to confirm this diagnosis... Scott, Madison, WI

A. The problem with your child's eye, the 'wandering eye' or being crossed eye, is called strabismus. It is estimated that about two percent of children have strabismus. In addition to eye drops and glasses, surgery is sometimes necessary to treat strabismus.

And keep in mind that almost 14% of children can have developmental delays.

Strabismus and Developmental Delays

Strabismus can be an isolated problem or it can be associated with certain other medical and genetic problems. Instead of a specific condition, your Pediatric Ophthalmologist was likely just suggesting that your child be screened for other problems.

While many children with developmental delays don't have a specific diagnosis for their problems, even after extensive testing, when you have more than one problem, it raises the possibility that there is a condition that you can find with testing.

Cerebellar hypoplasia is one condition that can cause developmental delays, speech delays, and strabismus, but these children also often have microcephaly (small head size) and seizures.

Most other syndromes that have strabismus as a sign also often have many other symptoms, like poor growth and specific physical features. The National Organization of Rare Diseases lists quite a few disorders that can have strabismus as a feature. Most are rare though and likely don't fit your child's pattern of symptoms.

If the Pediatric Ophthalmologist was concerned about a specific condition, it would be helpful to know what that is, so you might call and ask.

You also should likely talk to your pediatrician about this to see if a CT or MRI is indicated. Or perhaps you could ask for a referral to a Pediatric Neurologist to look into this further. According to a practice parameter from the Child Neurology Society, an MRI is often done in the evaluation of a child with global developmental delays. The AAP also states that "A comprehensive medical evaluation is essential whenever a delay is confirmed. This evaluation varies somewhat with the risk factors and findings and may include brain imaging, electroencephalogram (EEG), genetic testing, and/or metabolic testing."

Do keep in mind that the fact that he has been progressing in his development is a very good sign.