Pediatric Ocular Motility Disorders

Specialists in North Texas

Discovering that your child may be experiencing difficulties with eye movements can be disconcerting. As a parent, it’s natural to feel overwhelmed with worry and uncertainty. At Pediatric Eye Specialists, we recognize the emotional and practical challenges that ocular motility disorders can present.


Expert Ocular Motility Disorder Treatments for North Texas

Our aim is to provide not just exceptional medical care, but also the support and reassurance you need during this time. When it comes to disorders like nystagmus, ophthalmoparesis, or internuclear ophthalmoplegia, it’s crucial to have a trusted partner in your child’s vision care. We guide parents through the complexities of these conditions, offering clarity and hope. This article will provide you with a deeper understanding of ocular motility disorders beyond the more commonly known strabismus conditions, which are comprehensively covered in our dedicated pages for strabismus, esotropia, and exotropia.
Dr. Norman with patient

The Basics: What Is an Ocular Motility Disorder?

An ocular motility disorder refers to a condition where the movement of the eyes is abnormal or limited, affecting how the eyes can follow, fixate, and look at objects in various directions. These disorders can stem from issues with the muscles that control eye movements, the nerves that send signals to them, such as the oculomotor, trochlear, and abducens nerves, or the brain areas that coordinate these signals. Symptoms can include diplopia (double vision), difficulty tracking moving objects, and strabismus (misalignment of the eyes), which can lead to challenges in perceiving depth and maintaining clear vision. Accurate diagnosis and treatment are essential for managing these disorders to support a child’s visual development and overall quality of life.

Why Choose Pediatric Eye Specialists for Your Child's Ocular Motility Disorder?

The Most Experienced Team in North Texas

With over sixty-five years of collective pediatric ophthalmology expertise, we offer your child unparalleled collaborative care.

Four Convenient Locations

Easily accessible care with offices in Fort Worth, Denton, Southlake, and Mansfield, with expansion into Prosper in the near future. 

Unrushed, Clear Communication

We take the time to discuss your child's diagnosis and treatment, ensuring all your questions are answered to ease your concerns.

Affiliated with Cook Children’s Hospital

Our partnership with Cook Children’s Hospital means if your child needs surgery, imaging, or other specialists, they will be treated in one of the nation’s leading pediatric hospitals.

Specialized Expertise

Our expertise means that more optometrists, doctors, and specialists refer their pediatric eye patients to Pediatric Eye Specialists than any other pediatric eye practice in North Texas. 

Child + Family-Focused

Kids love us, and we love kids! We provide a caring environment for your child and your family.

Advanced Diagnostic Technology

We have the most comprehensive pediatric diagnostic suite in North Texas, allowing for precise diagnosis and highly personalized treatment plans. 

Every Child Needs Access to Expert Eye Care

Championing the right to sight, we help you navigate insurance, cash pay, and Medicaid options to make superior eye care feasible for all children regardless of their socioeconomic status.

Dr. Packwood with patient

Benefits of Ocular Motility Disorders Treatment

Addressing ocular motility disorders not only improves your child’s vision and eye coordination but also enhances their learning capabilities, social interactions, and overall confidence, fostering a better quality of life and healthy development.

Success You Child Can Expect

Enhanced Visual Acuity

Achieving clearer vision can dramatically improve your child's ability to learn and interact with the world.

Developmental Support

Proper treatment can promote normal visual development, essential for a child's growth and learning.

Increased Confidence

As visual function improves, so too does a child's social confidence and academic performance.

Prevention of Complications

Early intervention can help prevent associated conditions such as amblyopia, often referred to as lazy eye.

Comprehensive Care

Our commitment to long-term monitoring ensures that we can adapt treatment plans as your child grows and their needs change.

Empowerment and Education

We provide families with the knowledge and resources they need to manage ocular motility disorders effectively.

Real Stories,
  Real Smiles.

Hear from happy families enjoying a brighter future.

Start your child’s journey to better vision today.

Embrace a future of clearer vision and confidence for your child. Contact us now to book your consultation at any of our convenient locations across the Metroplex.

Causes of Pediatric Ocular Motility Disorders

Ocular motility disorders in children can arise from a complex interplay of genetic, developmental, and environmental factors. Understanding these underlying causes is critical to crafting a targeted treatment strategy. Here’s a closer look at the potential causes:

Genetic Influences

Some ocular motility disorders are hereditary, passed down from parent to child. These can include congenital conditions affecting the development and function of the eye muscles or the nerves that control them.

Developmental Issues

Disorders of the brain’s development can impact the intricate system that governs eye movements. Conditions such as cerebral palsy or developmental delays may manifest with ocular motility disorders as a secondary symptom.

Neurological Conditions

The brain and its neural pathways play a central role in coordinating eye movements. Any disruption in this system, such as a brain injury, tumor, or neurological diseases like multiple sclerosis, can lead to ocular motility disorders.

Muscle Pathology

The muscles responsible for moving the eyes can be affected by various conditions, from structural abnormalities to diseases like myasthenia gravis (a chronic autoimmune disorder characterized by muscle weakness) that interfere with muscle function.

Vascular Anomalies

Compromised blood flow due to stroke or vascular malformations in the brain can affect the nerves controlling eye movements, resulting in motility issues.

Infections and Inflammation

Infections that impact the brain, nerves, or eye tissues, such as meningitis or encephalitis, can temporarily or permanently alter ocular motility.


Head injuries that damage the brain, nerves, or eye muscles can lead to immediate or delayed ocular motility disorders.

Metabolic and Endocrine Disorders

Conditions like diabetes or thyroid disease can affect both the nerves and the muscles involved in eye movement, leading to motility problems.

Medication and Toxin Exposure

Certain medications or toxins can have side effects that impact the nervous system and, consequently, eye movements.

Pediatric Eye Specialists takes a thorough history and performs comprehensive examinations to identify the specific causes of ocular motility disorders in each patient. This careful approach ensures that the treatment plan is not only effective but also personalized for the best possible outcome for the child.

Understanding these causes is vital for Pediatric Eye Specialists in diagnosing and formulating an effective treatment plan for ocular motility disorders.

Ocular Motility Disorder Symptoms

Identifying the symptoms of ocular motility disorders in children can be challenging, as they may vary depending on the specific type of disorder and the underlying cause. Here are some common symptoms to watch for:

Diplopia (Double Vision)

Children may see two images of a single object, either constantly or intermittently. This can be disorienting and affect their ability to focus on tasks.

Strabismus (Misalignment of the Eyes)

One or both eyes may turn inwards (esotropia), outwards (exotropia), upwards, or downwards, indicating a problem with eye alignment.

Nystagmus (Involuntary Eye Movements)

Rapid, uncontrolled movements of the eyes, either side-to-side, up-and-down, or in a circular pattern, can occur, making it difficult to maintain steady vision.

Difficulty Tracking Moving Objects

Children may have trouble following moving objects smoothly, which can impact their ability to participate in activities like reading or playing sports.

Eye Fatigue

Prolonged use of the eyes, such as during reading or screen time, can lead to significant eye strain and fatigue.

Head Tilt or Turn

To compensate for misaligned vision, children might frequently tilt or turn their head to one side, attempting to achieve better alignment and focus.

Poor Depth Perception

Difficulty in judging distances accurately, which can affect tasks like catching a ball or navigating stairs.

Blurry Vision

Objects may appear out of focus, making it hard for children to see clearly and perform tasks that require precise vision.


Straining to compensate for vision problems can lead to frequent headaches, especially after prolonged visual tasks.

Squinting or Closing One Eye

Children may squint or close one eye to improve vision and reduce double vision or blurriness.

Difficulty in School

Vision problems can affect academic performance, as children may struggle to read, write, or concentrate on their schoolwork.

Early detection and treatment of these symptoms are crucial to prevent long-term visual impairment and to support a child’s overall development and quality of life. If you notice any of these signs in your child, it’s important to seek a professional evaluation from Pediatric Eye Specialists to determine the appropriate course of action.

Have Concerns?

Early detection and treatment of these symptoms are crucial to prevent long-term visual impairment and to support a child’s overall development and quality of life. If you notice any of these signs in your child, it’s important to seek a professional evaluation from Pediatric Eye Specialists to determine the appropriate course of action.

Diagnosing Pediatric Ocular Motility Disorders: Precision and Process

The accurate diagnosis of ocular motility disorders in children is a critical step in ensuring effective treatment. Pediatric Eye Specialists employs a meticulous process involving a battery of tests to pinpoint the exact nature of the disorder:

Comprehensive Eye Examination

This initial step assesses the child’s visual acuity, refraction, and the health of the eye structures. It helps to rule out any other ocular conditions that might be contributing to motility issues.

Patient History

A detailed medical history is taken to understand any genetic predisposition, previous illnesses, developmental milestones, or incidents that might have affected the child’s ocular motility.

Observation of Eye Movements

Doctors observe the child’s eye movements to identify any abnormal patterns, such as nystagmus (uncontrolled eye movements), strabismus (misalignment of the eyes), or other irregularities.

Cover Test

This test determines how the eyes move to pick up a target when the other eye is covered, revealing any latent strabismus or tendencies for the eyes to turn in, out, up, or down.

Ocular Motility Test

By having the child follow a moving object, doctors can assess the smoothness, speed, and coordination of the eye movements.

Neurological Assessments

These are crucial since many ocular motility disorders are rooted in neurological dysfunction. Reflexes, muscle strength, and cranial nerve function are evaluated.

Imaging Studies

MRI or CT scans of the brain and orbits may be conducted to look for structural causes of motility disorders, such as brain abnormalities or injuries.

Electrophysiological Tests

Tests like the electrooculogram (EOG) and visual evoked potentials (VEP) measure the electrical activity of the muscles and nerves associated with eye movements.

Binocular Vision Assessments

Tests to evaluate the child’s ability to use both eyes together can provide insights into how motility disorders are affecting binocular vision and depth perception.

Blood Tests

These may be necessary to identify any underlying systemic conditions that could be affecting ocular motility, like thyroid disease or myasthenia gravis.

Consultations with Other Specialists

For comprehensive care, consultations with neurologists, endocrinologists, or other specialists may be needed to address all aspects of the child’s health that could impact ocular motility.

Armed with the information from these diagnostic tools, the specialists at Pediatric Eye Specialists can determine the cause and extent of the ocular motility disorder and develop an individualized treatment plan. Their goal is to ensure the best possible visual outcomes and overall quality of life for their pediatric patients.

Treatments for Pediatric Ocular Motility Disorders

Treating ocular motility disorders in children requires a personalized approach that may involve a variety of therapies. Pediatric Eye Specialists offers a spectrum of treatments, ranging from conservative to advanced surgical options, each tailored to the child’s specific condition and needs.

Conservative Management

Optical Aids

Glasses, sometimes with prism lenses, can help correct or compensate for certain ocular motility disorders, reducing symptoms like double vision.


In cases where ocular motility disorders are associated with a systemic condition, appropriate medications can manage the underlying issue.


To address conditions like amblyopia that may accompany motility disorders, patching the stronger eye can help improve the function of the weaker eye.

Lifestyle Adjustments

Recommendations for changes in daily activities or environmental modifications to help manage the symptoms more effectively.

Surgical Interventions

Strabismus Surgery

Corrective surgery on the muscles that move the eye can realign the eyes and improve motility.

Neurological Surgery

In rare cases involving brain lesions or nerve damage, neurosurgery may be considered.

Muscle Transposition Procedures

Surgically repositioning eye muscles can restore more normal movement in cases of nerve palsies or muscle paralysis.

Adjustable Sutures

For some strabismus surgeries, using adjustable sutures allows for fine-tuning of the eye alignment postoperatively.

Botulinum Toxin Injections

Injecting botulinum toxin into specific eye muscles can temporarily weaken them, allowing for retraining of the eyes’ alignment.

Supportive Therapies

Occupational Therapy

OT can assist with the development of fine motor skills and coping strategies for daily tasks affected by ocular motility disorders.


Psychological support can aid children and families in addressing the emotional and social challenges that can accompany these disorders.

Multidisciplinary Care

Coordination with other healthcare providers ensures that all aspects of the child’s health are considered in the treatment plan.

Monitoring and Follow-Up

Regular follow-ups are essential to monitor the effectiveness of treatment, make necessary adjustments, and ensure the best possible long-term outcomes.

Educational Support

Working with schools and educators to implement accommodations can help the child succeed academically despite their visual challenges.

The experts at Pediatric Eye Specialists are committed to exploring all avenues to restore and enhance each child’s ocular motility. They aim to not only improve the mechanics of eye movement but also to ensure the child enjoys the highest quality of life with the best possible visual function.

Our commitment at Pediatric Eye Specialists is to provide your child with the highest standard of care, combining medical expertise with compassion and understanding.

Expected Outcomes for Pediatric Ocular Motility Disorder Treatments

When considering treatments for pediatric ocular motility disorders, Pediatric Eye Specialists strives to set realistic expectations for parents. The prognosis and recovery can vary greatly depending on the individual child’s condition, but here are some typical outcomes we strive to see patients experience.

Enhanced Eye Movement Control

Treatment often leads to improved control over eye movements, contributing to better coordination and tracking abilities.

Reduction of Symptoms

Some children experience a significant reduction in symptoms, such as decreased double vision, which can lead to improvements in daily activities and learning.

Stabilization of Condition

In many cases, with appropriate treatment, the progression of ocular motility disorders can be stabilized, preventing further deterioration of vision.

Adjustment Period

After treatment, there is often an adjustment period where the child adapts to changes in vision or eye movement. Supportive therapies can assist during this transition.

Long-Term Management

Some ocular motility disorders may require ongoing management, including adjusting glasses strength or follow-up surgeries.

Collaborative Care

A multidisciplinary approach ensures comprehensive management of associated conditions, contributing to overall positive outcomes.

Customized Follow-Up Plans

Each child will receive a personalized follow-up plan to monitor recovery and make necessary adjustments to the treatment plan.

Support Networks

Pediatric Eye Specialists provides resources and support networks for families to share experiences and coping strategies, enhancing the support system available during recovery.

Parents are encouraged to maintain open lines of communication with their child’s care team at Pediatric Eye Specialists. Regular updates and discussions about the child’s progress will help tailor ongoing treatment and ensure the family is informed and involved every step of the way.

Secure a Brighter Future: Schedule Your Child's Ocular Motility Consultation Today

Take the first step towards ensuring your child’s visual health and overall well-being. At Pediatric Eye Specialists, we are committed to providing comprehensive care and tailored treatment plans for ocular motility disorders. Early intervention is crucial for the best outcomes. Don’t wait—schedule a consultation with our experienced team today and give your child the gift of clear, coordinated vision and a brighter future.

Doctor and Patient

Start your child’s journey to better vision today.

Embrace a future of clearer vision and confidence for your child. Contact us now to book your consultation at any of our convenient locations across the Metroplex.

What are the long-term effects of ocular motility disorders in children?

Ocular motility disorders can affect a child’s visual development. If untreated, they may lead to problems with depth perception, visual acuity, and in some cases, social or learning difficulties due to the challenges with visual tasks. However, with proper treatment, many children can achieve good vision and learn to manage their condition effectively.

Can ocular motility disorders affect learning and reading?

Yes, these disorders can impact a child’s ability to track text while reading, leading to difficulties in learning and maintaining concentration. Vision therapy, corrective lenses, or surgery may help improve their reading ability and academic performance.

Are ocular motility disorders genetic?

Some ocular motility disorders may have a genetic component, making them more common in families with a history of eye movement problems or related neurological conditions.

How do ocular motility disorders interact with other pediatric conditions, like ADHD or autism?

Children with ADHD or autism spectrum disorders might exhibit behaviors that can be confused with ocular motility disorders, such as difficulty focusing visually. Conversely, unresolved ocular motility issues can exacerbate attention problems. It’s essential to diagnose each condition accurately to provide appropriate treatments.

Can ocular motility disorders be prevented?

While not all ocular motility disorders can be prevented, especially those with a genetic basis, regular eye examinations can detect issues early on. Additionally, protecting your child’s head during sports and activities can help prevent trauma-related motility problems.

What types of specialists might be involved in treating my child’s ocular motility disorder?

Treatment can involve a team of specialists, including pediatric ophthalmologists, neuro-ophthalmologists, orthoptists, and in some cases, neurologists or endocrinologists, depending on the underlying cause.

How can I explain my child’s ocular motility disorder to their school?

It’s best to provide teachers with a simple explanation of your child’s condition and how it affects their vision. Sharing any strategies or accommodations that help your child can also be beneficial. A formal Individualized Education Program (IEP) or 504 plan might be necessary for some cases.

What causes diplopia (double vision) in children?

Diplopia in children can be caused by a misalignment of the eyes due to imbalances in the extraocular muscles or issues with the nerves that control eye movements, such as the oculomotor or abducens nerves. It can also result from conditions like oculomotor nerve palsy or congenital birth defects affecting visual perception.

How does oculomotor nerve palsy affect eye movement?

Oculomotor nerve palsy can cause problems with eye movements controlled by the extraocular muscles, leading to misalignment and an inability to coordinate both eyes effectively. This may result in amblyopia (decreased vision in one eye), double vision, difficulty with fixation, or ptosis (drooping of the eyelid).

Can progressive supranuclear palsy impact my child’s vision?

Progressive supranuclear palsy is a rare brain disorder that can affect eye movement, leading to issues such as difficulty looking up or down, problems with balance and coordination, and potentially visual impairment.

What is sixth nerve palsy and how does it relate to pediatric ocular motility disorders?

Sixth nerve palsy, or abducens nerve palsy, is a condition that affects the lateral rectus muscle, responsible for moving the eye outward. In children, it can result in the eye turning inward, leading to crossed eyes or double vision.

How can convergence insufficiency cause visual problems in children?

Convergence insufficiency is a condition where the eyes do not work together while focusing on nearby objects. This can cause visual discomfort, blurred or double vision, and challenges with tasks that require sustained visual focus, like reading.

What is cyclotropia, and how does it affect a child’s vision?

Cyclotropia is a type of strabismus where one or both eyes rotate around the visual axis. It can disrupt binocular vision and cause a child to experience double vision or misperceived images, which may impact their daily activities and learning.

Can ocular motility disorders lead to learning difficulties?

Yes, ocular motility disorders can interfere with a child’s ability to control eye movements and maintain visual fixation, which is crucial for reading and learning. Children with these disorders might struggle with tasks that require precise visual attention, potentially impacting their academic performance.

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