Well I first found minti.com while searching the internet for more information about esotropia, ambliopia and strabismus. My now 10 month old son had suddenly started rubbing and squinting his eyes. At the time, he was maybe 8.5 months. In a matter of 2 weeks, he was crossing his eyes

occasionally; more so when he was focusing on something far away. At first I thought I was just seeing things. I had just gotten a new pair of eyeglasses (after wearing contact lenses) and was trying to get used to wearing glasses again. By the end of that second week (it was a Friday) he was turning his head to one side and focusing primarily with the 'good eye' because his 'bad eye' was 'crossed'. I immediately called his doctor who immediately referred me to a pediatric opthamologist. I have to say that I give a lot of credit to my pediatrician for trusting me to be an observant mother, and not brushing me off as fretful. His initial assesment was alternating esotropia and ambliopia.

At any rate, while waiting for our appointment with the eye doctor , I was told to watch my son for signs of dragging or no longer using his arms/legs....stroke symptoms. On Sunday I ended up taking him in to the ER because he wasn't closing his mouth to eat, but letting his mouth sort of 'drop down' and using his hand to push food back into his mouth. To be cautious his pediatrician said it best for us to head into the ER. They gave him a CT Scan (which was VERY overwhelming to see my little boy screaming inside that large machine!!). As a nursing student and OR tech I am pretty familiar with hospitals and procedures....but that was a lot for even me. Thankfully everything was clear on the CT.

The following week we went to see the eye doctor. He dilated Myles' pupils to get a better view of the optic nerve and behind the eye. He saw no signs of blockage or swelling, all of which was great to hear. And being that he'd had the CT Scan over the weekend, he had no reason to believe there was a tumor or anything present; the age at which the symptoms began was not common of strabismus, and he'd had no recent immunizations. Which led him to a diagnosis of 'sixth nerve palsy'. Usual diagnosis consists of dilation of the pupils, a MRI (or CT) and possibly a lumbar puncture.

The sixth cranial (skull) nerve is the nerve that controls the abduction, or pulling outward, of the eye. Sixth nerve palsy is when the sixth cranial nerve becomes irritated or inflammed, and therefore is unable to abduct. This inflammation can come from a cold, vaccines or other similar virus. Because the nerve emerges near the bottom of the brain, it is often the first nerve compressed when there is any rise in intracranial pressure. My understanding (from the doctors and the internet) is that this nerve can also become irritated or affected from a fall. This is especially the case in older children and/or adults. The inability to abduct the eye causes the eye(s) to cross and have double vision. That is why the head tilt occurs. Myles was turning his head to one side in order to line his eyes up and avoid the double vision. The eye doctor assured me that this was a good thing, as he was preserving the vision in his 'bad eye' by still using it. The eye doctor believes that the virus/inflammation will clear up in about 6 weeks and the eye should return to a normal position and regain abduction. He didn't suggest any type of treatment. My concern is whether or not we should use patching in order to strengthen the 'bad eye's' vision since it has not been getting normal use.

So...we have an appointment on May 21 with the eye doctor. Patching is something I plan to bring up during our visit. And I will continue to update any progress or new information as I get it. At this point I've actually seen Myles start to abduct his 'bad eye'. This began for the first time over this past weekend. His head tilt has also become less prominent this week.

There is very little information regarding this type of palsy, especially in infants. I found several pages on the internet but they all basically said the same things. Both my pediatrician and eye doctor were only able to give me limited information. Or maybe it just seemed limited to me...I must admit that I am almost anal about details and research. I've listed the most informative and easy to understand links below. I hope this helps anyone who may be looking for a diagnosis to a lazy-eye or crossed-eye(s) or similar eye issues.

http://www.eyemdlink.com/Condition.asp?ConditionID=412  

http://www.answers.com/topic/sixth-nerve-palsy

http://www.members.aol.com/scottolitsky/cn6.htm