STRABISM IN CHILDREN
What is Strabismus (Crossed Eyes)?
Strabismus (crossed eyes) is a common eye condition among children and is a phenomenon where the eyes are not in the correct position and are directed in different directions. One eye can look straight ahead while the other eye turns in, out, up, or down. Misalignment can move from one eye to the other.
Strabismus affects the vision, since both eyes must be focused on the same place together in order to see correctly. If the eyes are properly oriented during childhood, vision should develop well. But if the eyes are not aligned, a condition called amblyopia can develop. This is the phenomenon when the poorly focused eye has poor vision.
What causes strabismus?
In order for the eyes to focus in one direction, all the muscles of both eyes must be balanced. The brain controls these muscles. Children who have strabismus may have disorders that affect the brain. Some of these problems may include:
- Cerebral paralysis
- Down syndrome
- Hydrocephalus (extra fluid in the brain)
- Brain tumor
- Premature birth
Cataracts (cloudiness of the eye’s naturally clear lens) or eye injury can also be a cause of strabismus. Most children with strabismus do not have any of these problems. The fact that there are family members who have had strabismus can increase the child’s chances of inheriting it.
How does strabismus affect vision?
With normal vision, both eyes are focused on the same place. The brain combines the two images. from our eyes into a single, three-dimensional (3-D) image. This is how we can tell how close or far something is from us (called depth perception). When one eye is out of alignment, two different images are sent to the brain. At a younger age, the brain learns to ignore the image of the eye that is not pointing in the right direction. Instead, it only sees the image from the better eye. As a result, the child loses depth perception. Adults who develop strabismus after childhood often have double vision. This is because the brain has already learned to receive images from both eyes. Their brain can’t ignore the image from the non-directed eye, so they see two images.
Signs of strabismus
It is possible to notice that the child’s eyes look in different directions at the same time. It may also be observed that the child closes one eye or tilts the head when looking at an object. This may be your child’s way of making both eyes work together – this is a sign of strabismus. Also, your child may squint in one eye when in bright sunlight.
A pediatrician, school nurse, or teacher can also notice these signs. If you think your child may have strabismus, be sure to visit an ophthalmologist for a complete eye examination.
Pseudostrabismus
When children are less than a year old, their eyes may appear crossed when they are not. This is called “pseudostrabismus”. It usually occurs if the child has a wide, flat nose or a fold of skin on the inner eyelid.
A child can outgrow pseudostrabismus, but not strabismus.
Pseudostrabismus, although the eyes appear misaligned, the reflection of light is in the same place in both eyes
The photo shows an off-center light reflection on the left eye – a sign of strabismus.
Types of strabismus
There are three common types of strabismus.
- Infantile esotropia is when a baby or younger child has eyes that turn inward.
- Accommodative esotropia is the most common type of strabismus in children older than 2 years. One eye may turn inward (toward the nose) when focusing on a near or distant object.
- Exotropia is when one eye turns outward (away from the nose) when looking at something far away. This can happen sometimes when the child is tired, sick, or at bedtime. The child could also squint with one eye in bright sunlight.
Treatment of strabismus
One or more types of strabismus treatment may be recommended, depending on the age of the child and the alignment of the eyes. Babies and very young children with an inward-turning eye (esotropia) may need surgery or glasses. Strabismus surgery can lead to proper alignment of the eyes and enables the development of good vision. Children older than 2 years with esotropia may be prescribed special exercise glasses. Closing the healthy eye can be recommended with the aim of strengthening the non-directed eye which is weaker than the other. Sometimes children are taught to do certain eye muscle exercises to help focus both eyes.
If glasses, closure or eye exercises do not help, surgery is recommended, which may be recommended at the very beginning without alternative methods if the doctor believes that this is the only effective way of treatment.
Strabismus surgery
Surgery is often done to make the child’s eyes align properly. It is performed in the operating room of our clinic. The doctor makes a small incision in the conjunctiva of the eye to access the eye muscles. The muscles are then corrected in order to direct the eyes correctly. This can be performed on one or both eyes. After strabismus surgery, the child can return to their daily routine within a few days
As with any surgery, there are risks with strabismus surgery. Although rare, they can be serious. Our medical team will discuss these risks and benefits of surgery with the parents.
Strabismus surgery is usually a safe and highly effective way to treat misalignment of the eyes. Strengthening the child’s eye muscles is very important for a child’s good vision.
STRABISM IN ADULTS
Adult strabismus (crossed eyes) is when your eyes are misaligned and point in different directions. One eye can look straight ahead while the other eye turns in, out, up, or down. Misalignment can move from one eye to the other.
Strabismus affects the vision, since both eyes must be focused on the same place together in order to see correctly.
There are six eye muscles that control eye movement
One muscle moves the eye to the right, and one muscle moves the eye to the left. The remaining four muscles move the eye up, down, and at an angle. In order to focus on one image, all six eye muscles must work together.
What causes strabismus in adults?
In order for the eyes to focus in one direction, all the muscles of both eyes must be balanced. The brain controls these muscles. People who have strabismus usually have a problem that can affect the eye muscles. Some of these problems may include:
- Health problems such as diabetes, thyroid disease (Graves’ disease), Myasthenia gravis, brain tumors, or stroke
- Accidents or head injuries
- Eye muscle damage during some kind of eye surgery
Most adults have strabismus since childhood. But sometimes it starts appearing later in life.
How does strabismus affect vision in adults?
With normal vision, both eyes are focused on the same place. The brain combines the two images. from our eyes into a single, three-dimensional (3-D) image. This is how we can tell how close or far something is from us (called depth perception). When one eye is out of alignment, two different images are sent to the brain. At a younger age, the brain learns to ignore the image of the eye that is not pointing in the right direction. Instead, it only sees the image from the better eye. As a result, the child loses depth perception. Adults who develop strabismus after childhood often have double vision. This is because the brain has already learned to receive images from both eyes. Their brain can’t ignore the image from the non-directed eye, so they see two images.
What are the symptoms of strabismus in adults?
The most obvious symptom is eyes that are out of alignment. Adults with
with strabismus, I can also notice these other symptoms:
- Weakness in or around the eye, or a feeling that something is pulling around your eye.
- Vision changes, such as double vision (seeing two out of one image), blurred vision, trouble reading, or loss of depth perception.
- Constantly tilting or turning the head to the side to see the image clearly.
The symptoms of strabismus can be constant, or they can appear or disappear.
Treatment of strabismus in adults
There are several ways to treat strabismus in adults.
Operation
This is the most common form of strabismus treatment. The surgery can achieve alignment of the eyes and help restore proper vision. Usually, strabismus occurs when the muscles around the eyes are either too stiff or too weak. During surgery, the ophthalmologist can loosen, tighten, or move certain eye muscles so that the eyes are aligned to work together. In some cases, more than one surgery may be needed to treat strabismus.
The operation is performed in the operating room of our clinic, with general or local anesthesia. The doctor makes a small incision in the conjunctiva of the eye to access the eye muscles. The muscles are then corrected in order to direct the eyes correctly. This can be performed on one or both eyes. After strabismus surgery, you can return to your daily routine within a few days.
Exercises for eye muscles
Our medical team will teach you post-surgery exercises to focus both eyes in the same direction. These exercises can also help if you have “convergence insufficiency.” Then your eyes work poorly for close-up tasks, such as reading or working on the computer.
It is never too late to treat strabismus.
Living with the discomfort and problems caused by unfocused eyes is really unnecessary. Our medical team will find an adequate treatment for your strabismus treatment with long-lasting effects.
