incubation HOME CARE • None. See your doctor. PRECAUTIONS • If the pupils of the child's eyes are not equally black, smoothly round, and the same size, see your doctor. • If your child's eyes are not parallel, see your doctor to avoid development of a lazy eye. • All children should have their vision checked annually beginning at the age of four or five. Crossed eyes Crossed eyes is a condition in which one or both eyes turn inward toward the nose. In many cases, it is caused by improper functioning of the eye muscles. The eyeballs are turned in all directions by six tiny muscles that lie within the bony socket of the eye. These muscles keep the eyes parallel when the child looks at a distant object (more than 20 feet away) and turn the eyes slightly inward when they are focusing on closer objects. Infants learn to focus their eyes during the first three to six months of life. The eyes may occasionally turn in (esotropia. or internal strabismus) or out (exotropia, or external strabismus) in relation to each other during this learning period. These conditions may briefly occur even up to the age of one year and still be considered normal. When an infant's eyes are continuously not parallel, when they are not parallel more and more often at any age, or when they are not parallel past the age of one, the situation is abnormal and requires your doctor's attention. To judge the straightness of a child's eyes, shine a light into the eyes while the child is looking straight ahead. The highlight should be at the same spot in each eye (as shown at the top). If the highlight is at different spots (as shown at the bottom), one eye may be crossed. Crossed eyes Although most cases of crossed eyes are caused by improper muscle function, some are caused by a vision problem in one or both eyes. Anything that can cause crossed eyes can also cause the development of a "lazy eye" (amblyopia ex anopsia). If lazy eye is not corrected by the age of four to six years, disuse may cause a loss of sight in that eye. SIGNS AND SYMPTOMS Watch the relationship of the eyes to each other as the child focuses near and far, looks to either side, and looks up and down. If the eyes seem to turn inward more than usual, consult your doctor. Be aware, however, that although many young children appear to have crossed eyes, their eyes are actually straight. Many infants and young children have an extra skin fold at the inner corners of their eyes (alongside the nose). This fold of skin appears because of the tininess of the bridge of the nose. This extra fold allows more white of the eye to show toward the temples than toward the nose, creating an illusion of crossed eyes. Straightness of the eyes is best judged by observing the position of the highlights in both eyes (the highlights are the points where light is reflected in the eyes). If the highlights are in the same position in both eyes, the eyes are parallel. HOME CARE There is no home treatment except under the supervision of your doctor. pox