Different Sized Eyes

Preschooler's eyes are not the same size

October 2003

My 3-1/2 yo son's right eye is noticeably smaller than his left eye. The size difference seems to be getting more noticeable as he grows. When I asked his pediatrician about the difference at his 3yo well-child checkup, she said it was not a medical concern unless the lid was overhanging the pupil and interfering with his sight, which it is not. For obvious reasons, though, I am worried even if the size difference doesn't present a medical problem. Has anyone's child had the same problem? If so, did s/he outgrow it? I assume nothing can be done to rectify the problem. Thanks for any responses. Worried mom

Our daughter has one eye that is slightly smaller than the other. Our pediatrician also said it was nothing to worry about. I took her to the UC Berkeley pediatric eye clinic to get her eyes checked and the person there said it could be an indicator of a sight problem. I can't remember what exactly, and there was little evidence that our daughter had any problems with her eyes, but she recommended I get routine eye exams just to monitor the situation. They are great there! An exam costs about $80 -- unless your insurance covers it. I felt fortunate to have such a wonderful resource in our community. anon

This child needs to be seen by a Pediatric Ophthalmologist right away (within two months). You might be describing a condition known as congenital ptosis (where the upper lid is a little droopy). This condition is known to cause astigmatism in one eye which can lead to amblyopia (''lazy eye''). There are other serious problems that can look like ptosis on the surface (such as neurofibromatosis). Occasionally the problem is not with the eye which looks smaller, but rather, the problem is in what you think is the normal eye. Lid retraction or exophthalmos in one eye can be interpreted as a smaller eye on the other side. These conditions could be caused by many things including orbital tumors, optic nerve gliomas, and more. Please have the child fully examined by a Pediatric Ophthalmologist. The most superlative one in the Bay area is Dr. William Good. He has offices in San Ramon, Walnut Creek, and San Francisco. If the child has any of these conditions, you have only a limited time to intervene before he could go blind or worse. If it proves to be nothing more than a cosmetic idiopathic ptosis, this is easily repaired if desired.

If you are so inclined, please post that you saw this posting. And, as an aside, general pediatricians have very little exposure to ophthalmology in both their medical school and residency training, so a consultation with a specialist is always ide

General Ophthalmologist Who Knows His Stuff