In article <yH9td.398202$a85.200265@fed1read04>,
"Mr. X" <greenbaboon1@cox.net> wrot

It is certainly possible that your ophthalmologist's assessment is
correct. She may have a simple over-convergance due to farsightedness
and/or a muscle spasm, but especially considering her history, there is
also the possibility of other causes for the condition and hence the
discussion of CAT scan or MRI scan.

Try to observe her eyes as she awakens from sleep and before she looks
at a close object. If her eyes are not crossed at that time, and do
cross when she looks directly at you, your worry level should come way
down. If, on the other hand, her eyes are significantly crossed upon
awakening, or if you observe any other unusual condition or behavior,
consider this to be a condition warranting immediate attention.

If further testing is required, the protocol would be to first perform a
cycloplegic refraction to determine the extent of the farsightedness,
which would also cause the eyes to uncross. Perhaps the doctor can
provide plus lenses and see if the eyes uncross. That might yield the
answer right there. And again, the worry level goes way down

If not, the next step would be an imaging of the brain. Some docs might
prefer the CAT scan because it is quicker and would not necessarily
require sedation or if so, less so than an MRI. But for a child, you
must way the risks and benefits. The CAT scan exposes her to a certain
amount of radiation, and is not as good a diagnostic tool, but it is
faster. The MRI takes longer to do, would likely require her to be
medicated and sedated, but will yield a better picture and perhaps an
easier diagnosis.

So don't worry too much yet, but do proceed immediately with further
testing and if there is any doubt of how the doctor is proceeding, do
consider a second opinion. And remember, that although you did provide a
reasonable presentation of the issues, advice given here is based on
that, and not on actually examination in person.

I hope that the answer is simple and she will be fine,  Do let us know
how this works out.

--LB. O.D.

I agree with Dr. Larry, with a couple of comments:

The nerves involved run along the bony floor underneath the brain. While a
CT scan may not show all the soft structures, many of the abnormalities that
affect soft tissue will also show up in the bone, especially with a history
of skull fracture, or they will displace the soft structures that are
visibile, like the ventricles..

When the eyes cross due to sixth nerve damage, it's blatantly asymmetrical.
It's much worse when looking toward the affected eye, and goes away when
looking toward the other side. Hold her head in your hands, face-to-face,
and turn her head back and forth. If it doesn't vary, it isn't 6th nerve.

There's a chance her eyes were crossing before you noticed it.

-MT, OD

"Mr. X" <greenbaboon1@cox.net> wrote in news:yH9td.398202$a85.200265
@fed1read04:

Tom-

First, your cross-eyed game has nothing to do with this.

Second, you seem understandably concerned.  I think that with your
daughters history and the apparent sudden onset (as others have pointed
out, this may have been there for awhile, and you just noticed it), a
referral to a pediatric neuroophthalmologist--preferably, one who
received most of his training on the neurology side, but any peds
neuroophth should do-- is not out of order.  If it were my daughter, I'd
make sure this happens, mostly because I'm a worrier and that would calm
me down.  In fact, if it comes down to MRI, I'd definately want a
neurologist or neuroophth to do the requesting, because that type of doc
might want a specific type of image that others might not request, and
then you'd just have to repeat the MRI, which isn't necessarily easy with
a three year old.      If I couldn't get a referral, I'd be tempted to pay
out of pocket (my guess would be in the $300 neighborhood), but this
might cause problems with getting your insurance to cover any expensive
imaging and other diagnostic testing.  

Last, I've got no medical training.  This is just what I'd do if it were
my own daughter.

Good Luck
Scott

Another wonderful case!

Why don't you try again to play cross-eyed so that you may increase the
strain and let it then disappear?

Also, you can try to swing your child, either in your arms or on a
swinging chair or on a swing in the park under the sun.

It should be interesting to ask to the doctor what has the six cranial
nerve to do if the inception of the cross-eyed condition just happened
after having done some exercises in straining the eyes to see at the
very near point?

I am interested in this case if the parents are willing to follow rest
methods treatments as taught bt Dr. Bates in the book Stories From The
Clinc, where they have reported many cases like this resolved in few
days.

Sudden  crossing DOES make sense in cases where it si accommodatie esotropia
caused by farsightedness. I see this frequently. Your friend's analysis that
it does not make sense may be wrong.

6th nerve paralysis is obvious. One eye will not be able to a abduct all the
way,a nd the eye crossing will be markedely different on right vs left gaze.
Should be obvious to the experienced ophthalmologist if it were 6th nerve.

Could be neurological, and if one were looking, yes, an MRI, not a CT, is
indicated. CT is not very good for neurological problems. However, a tumor
would be extremely rare, as would be an aneurysm or AV malformation.. The
issue of the old skull fx is probably too distant past to have relevance to
this new finding.

The least invasive way to work this up is order the glasses, and if it
resolves the crossing, no further workup is indicated. Note that an MRI at
this age would have to be done under heavy sedation to eliminate movement.

On 12/6/04 7:47 PM, in article yH9td.398202$a85.200265@fed1read04, "Mr. X"
<greenbaboon1@cox.net> wrote: