An 11-month-old girl with a history of developmental delay presented to the ophthalmology clinic because of concern that both of her eyes were crossing. Her mother reported that the crossing had been present since birth. The child also had to move her head in order to look to either side. Her mother reported that the child slept with her eyes open and did not seem to smile.
The child was born at 38 weeks' gestation by normal spontaneous vaginal delivery. She was fed by nasogastric tube, and a button gastrostomy was performed at 7 months of age as a result of feeding difficulties, including impaired suck and swallow. The child's mother denied any family history of vision difficulties or developmental delay.
On examination, the patient's facial expression was flat, and she had lagophthalmos with reduced ability to blink. Pupillary reflexes were brisk bilaterally. There was no afferent pupillary defect. She was able to fix and follow vertically with both eyes. Motility examination showed a left esotropia and bilateral abduction deficits (Figures 1-3).
Figure 1. Primary position.
Figure 2. Vertical gaze.
Figure 3. Right lateral gaze.
Medscape Ophthalmology © 2014
Cite this: The Baby Who Never Smiles - Medscape - Apr 03, 2014.