If you have a child with Lennox-Gastaut syndrome (LGS), you may notice certain symptoms that happen in everyday life, not just during seizures. These might include abnormalities in their facial movements or dental problems. For some kids, vision issues can be either a sign of LGS or a side effect of a medication they take for seizures. Some vision problems may be a complication of LGS.

In any case, Lennox-Gastaut syndrome seems to increase the risk of certain eye problems and vision issues. But eye problems common in kids with LGS may be more closely linked to their genetics or other factors than their seizure disorder. Current research about vision issues in LGS is limited, and more studies are needed to better understand the connection between this type of epilepsy and the eyes.

The Risk of Vision Issues in Epilepsy

In general, epilepsy increases the risk of vision problems, including:

• Photosensitivity — Sensitivity to light
• Homonymous hemianopia — Loss of vision in half of the visual field
• Visual hallucinations — Seeing things that aren’t there, such as patterns, shapes, and colors

Epilepsy medications can also cause vision issues as side effects. When vision problems come from a medication, they may go away after several weeks or months once the child has adjusted to the medication. While vision problems such as blurry vision may be listed as a side effect of a medication, not everyone who takes the medication will experience them.

Possible Vision Issues in Lennox-Gastaut Syndrome

A small study in Korea that evaluated 34 children with Lennox-Gastaut syndrome found that 88.2 percent of participants had some type of eye or vision problem. While this form of childhood epilepsy appears to increase the risk of ophthalmological issues, the exact connection between LGS and vision problems isn’t well understood.

Researchers know that Lennox-Gastaut syndrome is a developmental and epileptic disorder affecting the central nervous system (CNS), which includes the brain and spinal cord. Because the CNS is involved, this may lead to vision issues and problems with the oculomotor system (the part of the CNS that controls eye movements) that have been observed in kids with LGS.

Here are six ophthalmological issues that might happen with Lennox-Gastaut syndrome or as side effects of medications taken for seizure control:

1. Refractive Errors

Refractive errors are vision problems that make it hard to see clearly. They’re very common in the general population, affecting over 150 million people in the United States alone. Many people wear glasses or contact lenses to see more clearly while living with a refractive error.

There are three types of refractive error that may affect children with Lennox-Gastaut syndrome:

• Nearsightedness — Causes distant objects to appear blurry
• Farsightedness — Causes nearby objects to appear blurry
• Astigmatism — Causes distant or nearby objects to appear distorted or blurry

Refractive errors were the most common vision problems found in the Korean study. Astigmatism was the most common, affecting over 38 percent of participants. Farsightedness was the second most common, in 26.5 percent of participants, and 14.7 percent of participants had nearsightedness.

2. Strabismus

After refractive errors, strabismus was the second most common ophthalmologic issue observed in the Korean study, affecting almost one-third of participants. Strabismus, or misaligned eyes, can cause double vision. When someone has double vision or diplopia, they see two of the same image.

Three types of strabismus might affect children with Lennox-Gastaut syndrome:

Exotropia

If a child has exotropia, their eyes point outward and away from each other. In the Korean study, Exotropia was the most common type of strabismus among kids with LGS, affecting just over 20 percent of participants.

Esotropia

Children with esotropia have eyes that point inward, toward their nose. Almost 9 percent of participants in the Korean study had this type of strabismus. Both exotropia and esotropia are known as horizontal strabismus.

Vertical Deviation

Vertical deviation include types of strabismus such as hypertropia (eyes pointing upward) and hypotropia (eyes pointing downward). In the Korean study, just 2.9 percent of children with LGS had dissociated vertical deviation strabismus, where one eye drifts upward or downward when the other eye is covered or focused.

3. Cortical Visual Impairment

Cortical visual impairment is one of the most common causes of visual problems in young children (especially those under 3 years old) with neurological disorders. It involves unusual vision responses that are not due to eye problems but point to some type of brain dysfunction.

In the Korean study, 23.5 percent of participants showed signs of cortical visual impairment. Signs can include:

• Trouble focusing or fixating the eyes on an object
• Not responding to people’s faces
• Gazing at lights
• Being sensitive to light

While the connection between LGS and cortical visual impairment is not well understood, cortical visual impairment is closely associated with other conditions, including cerebral palsy, developmental delays, and epilepsy. About 64 percent of children with cortical visual impairment are diagnosed with some form of epilepsy.

4. Retinopathy of Prematurity

Retinopathy of prematurity is an eye disease that affects babies born prematurely (earlier than their due date) or who weighed under 3 pounds at birth. This condition occurs when abnormal blood vessels grow on the light-sensitive tissue in the back of the eye, called the retina.

Retinopathy of prematurity can be temporary or permanent and can cause symptoms in advanced cases. Babies with severe retinopathy of prematurity can experience symptoms such as:

• Nystagmus (shaking eyes)
• Wandering eyes
• White pupils
• Trouble recognizing faces
• Blindness (if the retina detaches)
• Myopia (nearsightedness)
• Strabismus

Just under 9 percent of children in the Korean study had retinopathy of prematurity, making it the fourth most common vision problem observed.

5. Blurry Vision as a Medication Side Effect

Blurred vision is a common side effect of many anti-seizure medications, especially during the first few weeks of treatment. This type of blurry vision is different from that caused by refractive errors, as it usually resolves on its own once a person has been taking the medication for some time.

6. Double Vision as a Medication Side Effect

Double vision may also occur as a side effect of some anti-seizure medications taken for many types of seizures. Double vision or blurry vision can happen if a child’s blood levels of the medication get too high. If double vision doesn’t improve, your child’s pediatric neurologist or epilepsy specialist may consider changing their medication.

Recognizing Signs of Vision Issues in Your Child

Most cases of Lennox-Gastaut syndrome are diagnosed when kids are under 10 years old, with the majority detected in early childhood between the ages of 3 and 5. Kids with LGS who experience vision issues may be too young to tell caregivers about their vision problems using their words. In such cases, you can spot possible signs of vision problems by observing certain behaviors:

• Tilting their head often
• Squinting their eyes or straining to see
• Being unable to follow moving objects with their eyes
• Having unusual eye movements, like shakes, jerks, or drifting
• Showing signs of eye strain or discomfort, like rubbing their eyes often

Talk to Your Doctor

If you notice signs of vision problems in your child, be sure to bring them up with your pediatrician. Your child’s pediatrician can evaluate them for eye problems that might be associated with Lennox-Gastaut syndrome or medications they take to prevent seizures.

Your child’s healthcare provider might recommend seeing an ophthalmologist to evaluate their eyes more thoroughly and tell you about their treatment options.

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