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Strabismus (Crossed Eyes)

One eye is turned in a different direction from the other in a condition known as strabismus (crossed eyes). Glasses, a patch, eye exercises, medicine, or surgery are all possible forms of treatment.

What is Strabismus (crossed eyes)?

The condition known as strabismus (crossed eyes) causes the eyes to not align properly. To put it another way, one eye is directed in a different direction than the other.

The six muscles that regulate eye movement normally cooperate to steer both eyes in the same direction. Patients with strabismus struggle to maintain proper ocular alignment (eye position) and have trouble controlling their eye movement.

Strabismus can be categorized by the direction of the turned or misaligned eye:

  • Inward turning (esotropia)

  • Outward turning (exotropia)

  • Upward turning (hypertropia)

  • Downward turning (hypotropia)

Other factors to consider that help determine the cause and treatment of strabismus:

  • Did the problem come on suddenly or over time?

  • Was it present in the first 6 months of life, or did it occur later on?

  • Does it always affect the same eye, or does it switch between eyes?

  • Is the degree of turning small, moderate, or large?

  • Is it always present, or only part of the time?

  • Is there a family history of strabismus?

What are the types of strabismus?

There are several forms of strabismus. The two most common are:

Accommodative Esotropia is when the eyes turn in naturally due to genetic predisposition (family history) and uncorrected farsightedness. The eyes may shift inward as a result of the additional focusing effort required to maintain distant objects in sharp focus because the ability to focus is tied to where the eyes are pointing. Double vision, covering one eye when gazing at something close, and tilting or twisting the head are all symptoms. Usually, this kind of strabismus develops within the first few years of life. The most common form of treatment for this ailment is wearing glasses, however, it may also call for an eye patch and/or surgery on one or both eyes' muscles.

Intermittent exotropia In this form of strabismus, one eye will occasionally fixate (concentrate) on a target while the other eye is pointing outward. Double vision, headaches, difficulties reading, eyestrain, and closing one eye when viewing distant things or in bright light are just a few of the symptoms that might occur. Patients may not experience any symptoms, but others may observe the ocular deviation (difference). Exotropia that comes and goes can occur at any age. Glasses, a patch, eye exercises, and/or surgery on one or both eyes' muscles are all possible treatments.

Infantile esotropia is a different kind of strabismus. Infants with this syndrome have significant inward bending of both eyes, which often begins before the age of six months. Typically, there isn't much farsightedness, and wearing glasses won't make the crossing go away. The tendency to turn inward may begin sporadically but eventually takes on a consistent character. Both when the child is looking far away and up close, it is there. Surgery to realign the muscles of one or both eyes is the treatment for this kind of strabismus.

Strabismus can also affect adults. Ocular misalignment in adults is most frequently caused by stroke, although it can also be brought on by physical trauma or untreated childhood strabismus that has returned or worsened. Adults with strabismus may benefit from a range of treatments, including prism glasses, patching, monitoring, and/or surgery.

How common is Strabismus?

13 million Americans, or 4% of the country's population, are thought to have strabismus.

What causes Strabismus?

The majority of strabismus is caused by abnormalities in the neuromuscular system that control eye movement. These brain's control centers are still being better understood. Less frequently, there is an issue with the eye muscle itself. About 30% of children with strabismus have a family member who also has the condition, proving that strabismus is a common inherited condition.

Other conditions associated with strabismus include:

  • Uncorrected refractive errors

  • Poor vision in one eye

  • Brain tumors

  • Stroke (the leading cause of strabismus in adults)

  • Head injuries, which can damage the area of the brain responsible for control of eye movement, the nerves that control eye movement, and the eye muscles

  • Neurological (nervous system) problems

When do the symptoms of strabismus appear?

An infant's eyes should be able to focus on small objects and be straight and well-aligned by the time they are 3 to 4 months old. A baby that is six months old should be able to focus on both close-up and distant objects.

Infants and young children are most commonly affected by strabismus, which typically manifests by the time a child is 3 years old. However, strabismus can also occur in older kids and even adults. In an older child or adult, the rapid onset of strabismus, particularly with double vision, may be a sign of a more severe neurologic condition. Make a quick call to your doctor if this occurs.

A disorder known as pseudostrabismus, sometimes known as false strabismus, can make it look as though a baby's eyes are crossed when they are actually pointing in the same direction. A flat nasal bridge and/or excess skin covering the inner corners of the eyes can also contribute to pseudostrabismus. The eyes will no longer appear crossed as the baby's face matures and grows.

How is strabismus diagnosed?

A pediatric ophthalmologist should do a thorough eye examination on anyone older than four months who exhibits symptoms of strabismus, spending considerable time looking at the eyes' focus and movement. The following things could be tested for:

  • Patient history (to determine the symptoms the patient is having, family history, general health problems, medications being used and any other possible causes of symptoms)

  • Visual acuity (reading letters from an eye chart, or examining young children’s visual behavior)

  • Refraction (checking the eyes with a series of corrective lenses to measure how they focus light). Children do not have to be old enough to give verbal feedback when checking for glasses.

  • Alignment and focus tests

  • Examination after dilation (widening) of the pupils to determine the health of internal eye structures

How is strabismus treated?

Treatment options include the following:

  • Eyeglasses or contact lenses

  • Prism lenses

  • Orthoptics (eye exercises)

  • Medications

  • Patchin

  • Eye muscle surgery

What can be expected after treatment for strabismus?

To determine how well the patient has responded to treatment and to make any required adjustments, the patient will need to follow up with the doctor.

Children with strabismus may benefit from great vision and depth perception, as well as protection from vision loss, if the disease is identified early and treated effectively.

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