Question:
About: Strabismus and Cerebral Palsey
I noticed my son's eyes crossing soon after he was born. We started seeing a doctor
for his strabismus at about 6 months who also diagnosed him as being slightly far sighted (his
eyes cross inward, by the way). By 18 months he wasn't walking without holding my hand to
keep himself up and would seem to tilt his head back while he walked. My pediatrician
thought it might be Cerebral Palsey (apparently there is a small % of CP kids that have
strabismus) so off we went to a series of specialists and to get an MRI (results were normal,
no CP or neurological damage detected). He finally started walking at 20 months but he
seemed and still seems to have depth perception; for example, he has trouble going down one
step, preferring to crawl down rather than take the small step). He also always tilts his head
up while he's walking or running (sometimes flailing his arms a bit, making it seem like he
has CP). Its almost like he's off-balance. Also, he seems to be unusually tired, even after
sleeping 10 hours he gets tired and will fall asleep the minute he's in a car or stroller. I've seen
3 eye doctors and various specialists (OT, PT, Orthopedic etc..) and none of them think there
is a correlation between the head tilt/balance and eye crossing.
My questions:
Is there any correlation between balance/head tilt and strabismus?
Will the head tilt/balance issues improve once his eyes improve either through glasses or
surgery or is it totally unrelated?
Is the excessive tiredness related to the eyes having to constantly strain?
(Karla)
Answer:
Dear Karla,
I agree that a direct relation between the brain disorder (it is a CP, not an ataxia ?) and the
squint is unlikely. Approx. .75% of infants squints and this figure is much higher in patients
with brain disorders. I recently diagnosed a case of "benign paroxysmal tonic upgaze with
ataxia" and that is one of the rare cases where a brain disorder (ataxia, clumsiness) is directly
related to and eye movement disorder and a head posture, but these infants have their chin
down, not up. To be able to say whether the head posture is caused by the squint, please tell
me whether the eyes are straight in downgaze. Then the eyes would move vertically according
to an A-pattern and then your last two questions could be answered affirmatively.
Yours truly,
(Herb Simonsz, MD, PhD)
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