Neonatal ocular misalignments reflect vergence development but rarely become esotropia

What is it about?

We followed 214 Infants born to orthoptist mothers for up to 15 years to see if those who were more frequently cross-eyed in early infancy were more likely to develop genuine strabismus in later childhood. Those who were misaligned more frequently before two months of age were later to achieve constant alignment but were earlier to attempt first convergence to near objects. Maximum squinting frequency was usually found at or before the onset of first convergence. Crossed eyes in the first 2 months of life seem to reflect a normally developing vergence system. Children destined to develop a genuine strabismus later were indistinguishable from visually normal children before 2 months.

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Why is it important?

Parents, health visitors and GPs can be reassured that intermittently crossed eyes in very early infancy can be normal. Infants with a constant squint or whose intermittent squinting is not getting better by two months and completely gone by four months should be referred for investigation.