Intermittent Crossed Eyes in a 2-Month-Old Infant
Intermittent esotropia (crossed eyes) during the first 3 months of life is normal and does not necessarily predict the development of constant strabismus. 1
Normal Visual Development in Early Infancy
- Infants' eye movements are initially jerky and inaccurate during the first few months of life, becoming smoother and more coordinated by around 6 months of age 2
- Binocular vision, accommodation, and depth perception begin to develop at 3-4 months of age 2
- During the first 3 months of life, some degree of intermittent eye misalignment is considered a normal part of visual development 1
- Visual development is incomplete at birth, with maturation of the visual system continuing throughout infancy 3
Understanding Infantile Esotropia vs. Normal Development
Normal Findings in Young Infants
- Intermittent esotropia (inward eye deviation) during the first 3 months is often transient and part of normal visual development 1
- Variable alignment that resolves spontaneously by itself is typically not concerning 1
- The visual system is still developing coordination between both eyes during this period 2
When to Be Concerned
- Constant (non-intermittent) esotropia before 6 months of age that doesn't resolve 1
- Esotropia that persists beyond 3-4 months of age 1
- Large angle of deviation (greater than 40 prism diopters) 1
- Esotropia associated with other neurological or developmental concerns 1
Risk Factors for Developing Persistent Strabismus
- Family history of strabismus 1
- Premature birth, especially with birth weight under 2000 grams 1, 4
- Neurodevelopmental impairment 1
- Significant hyperopia (farsightedness) 1
- Low birth weight or low Apgar scores 1
- Exposure to smoking or alcohol in utero 1
- Craniofacial or chromosomal anomalies 1
Monitoring and Follow-Up
- If the eye crossing is intermittent and variable at 2 months, continued observation is appropriate 1
- Most cases of intermittent esotropia in the first 3 months resolve spontaneously 1
- If esotropia persists beyond 3-4 months, becomes constant, or is associated with other concerns, ophthalmological evaluation is recommended 1
- Early diagnosis and treatment are essential if strabismus persists, as binocular vision can degrade rapidly in young children 1
Importance of Early Intervention if Strabismus Persists
- Persistent strabismus can lead to amblyopia (lazy eye) if left untreated 1
- Early treatment promotes binocular vision and improves visual function in each eye 1
- Untreated strabismus can affect depth perception and coordination 3
- Proper alignment is important for normal visual development and social interactions 1
Key Points for Parents
- Intermittent eye crossing at 2 months of age is typically normal 1
- Monitor whether the crossing becomes more frequent or constant 1
- If the crossing persists beyond 3-4 months, becomes constant, or is associated with other concerns, seek ophthalmological evaluation 1
- Early intervention is important if true strabismus develops to prevent long-term visual impairment 1