Are your or your child's eyes not aligned? Let's talk about Strabismus!

Have you ever noticed that your little one's eyes sometimes turn in different directions? Or that when one eye looks straight, the other eye seems to go in a different direction? Maybe you've experienced this yourself. This is what we call strabismus in medical terms, or crossed eyes. Don't worry, we'll talk about this in detail today.

What is Strabismus? Simply put...

Simply put, strabismus is a condition where your eyes are not pointing in the same direction. That is, one eye is looking in the opposite direction to the other. Think of it like two brothers working together. They both need to look at the same place.

Normally, there are six muscles around our eyes. These muscles help move the eyes from side to side, up and down. When all these muscles work together and coordinate properly, both eyes point in the same direction. However, in a person with strabismus, there is a problem with the functioning of these muscles. As a result, the normal position of the eyes (ocular alignment) cannot be maintained.

Although this condition is most common in young children , adults can also develop strabismus. The main cause of this in adults is stroke. It can also be caused by physical trauma. Sometimes, strabismus that was present in childhood, was not properly treated, or recurred after treatment, can also be present in adulthood.

What are the main types of strabismus?

There are different types of strabismus. Let's look at a few of them.

Commonly seen types

• Accommodative esotropia: This often occurs in people with untreated nearsightedness and those with a family history of inward-turning eyes. When we look at something, our eyes are in the direction we focus. So, when we have to work harder to see something far away, our eyes can turn inward.
• Intermittent exotropia: In this type, when one eye is fixed on a target, the other eye turns outward. Often, the eye may alternate between looking straight ahead and turning outward.
• Infantile esotropia: In this, both eyes turn significantly inward in young infants, that is, before the age of 6 months. These children often do not have significant farsightedness, and glasses do not correct this condition. Although the inward deviation occurs occasionally at first, it becomes permanent after a while. This deviation occurs both when looking at distance and near. The treatment for this is surgery on the muscles of one or both eyes to correct the deviation.

They are also classified according to the direction in which the eyes are turned.

Doctors classify strabismus based on the direction the eye turns, how often it happens, and whether it affects only one eye or both eyes alternately.

• If your eye turns inward , it is called esotropia .
• If your eye turns outward , it is called exotropia . (Both esotropia and exotropia are types of horizontal strabismus.)
• If your eye turns upward , it is called hypertropia .
• If your eye turns downward , it is called hypotropia . (Both hypertropia and hypotropia are types of vertical strabismus.)

Also, this situation:

• Strabismus can be constant or intermittent. Strabismus that occurs only occasionally is called transient strabismus.
• It can always be unilateral .
• Sometimes it may be one eye and sometimes the other (alternating) .

Sometimes strabismus can also be associated with nerve palsies. For example, conditions such as oculomotor palsy, superior oblique palsy, or abducens palsy. (These are caused by problems with our third, fourth, and sixth cranial nerves.)

How common is this condition?

According to estimates, about 4% of the population of the United States, or about 13 million people, have this eye twitching condition. This condition can also be seen in Sri Lanka.

What are the symptoms of strabismus?

If you or your child has strabismus, you may notice symptoms like these:

• Double vision .
• When looking at something nearby , one eye is closed or covered with the hand .
• Tilts or turns the head to one side .
• Headaches .
• It's difficult to read .
• Eyes feel tired (Eye strain) .
• When looking at something far away, or in a bright light, one eye is closed .

When do symptoms usually appear?

Strabismus is most often seen in newborns and young children . It usually appears when a child is 3 years old.

However, it is normal for your newborn baby's eyes to sometimes look crossed and to wander around . This will improve over time. By about 3-4 months , your baby's eyes should be able to focus on even small objects. They should also be straight and well-aligned. By 6 months, your baby should be able to see things that are close up as well as things that are far away.

Important: If an older child or adult suddenly experiences eye twitching , especially with double vision, it could be a sign of a more serious neurological condition . If this happens, you should see a doctor immediately .

Is it really possible to look like a bed without a bed? - That's pseudostrabismus

Sometimes, your baby's eyes may look like they are crossed when they are not. This is called pseudostrabismus, or false strabismus. This can happen if your baby has extra skin at the inner corners of their eyes or if the bridge of their nose is flattened. This appearance will go away as your baby's face grows and develops.

What are the causes of strabismus?

Most often, strabismus is caused by a problem with the neuromuscular control of the eye movement. This involves the brain. Rarely, it is caused by a problem with the eye muscle itself. Another cause is family history . About 30% of children with strabismus have a family member with the same problem.

Risk factors for strabismus

There are several other risk factors that can contribute to eye strain:

• Uncorrected refractive errors.
• Weak vision in one eye.
• Cerebral palsy condition.
• Down syndrome (about 20% - 60% of people with Down syndrome have strabismus).
• Hydrocephalus (a congenital condition in which fluid builds up in the brain).
• Brain tumors.
• Stroke (the leading cause of strabismus in adults).
• Head injuries - These can damage the area of ​​the brain that controls eye movement, the nerves that control eye movement, and the muscles of the eyes.
• Neurological problems.
• Graves' disease (overproduction of thyroid hormone).

What are the possible complications of strabismus?

Some people think that squint in young children will get better as they get older. In fact, if left untreated, the condition can get worse.

If your eyes are not aligned properly, problems like these can occur:

• Lazy eye (amblyopia) is a permanent loss of vision in the affected eye. When the eyes look in different directions, the brain receives two images. To prevent double vision, the brain can ignore the image coming from the affected eye. This causes the vision in that eye to develop poorly.
• Blurry vision , which can affect schoolwork, work, hobbies, and leisure activities.
• Eye strain.
• Fatigue.
• Headaches.
• Double vision.
• Poor three-dimensional / 3D vision . This means that the ability to perceive depth is reduced.
• Low self-esteem (may be embarrassed about the way your eyes look).

Also, if a doctor does not recognize and pay attention to strabismus, a serious problem like a brain tumor may be missed .

How is strabismus diagnosed?

Any child over 4 months of age who appears to have a strabismus should have a complete eye exam by a pediatric ophthalmologist. This exam will look specifically at how the eyes focus and move. This exam may include:

• Medical history ( find out about symptoms, family history, general health problems, medications used, and other factors that may be affecting symptoms).
• Visual acuity ( reading letters on an eye chart or testing the visual behavior of young children).
• Refraction test (measures how well the eyes focus light by fitting the correct set of lenses). Children do not need to be old enough to talk when they are tested for glasses.
• Alignment and focus tests .
• Examining the health of the internal structures of the eye by dilating the pupils with eye drops.

There are several other factors that can help determine the cause and treatment of strabismus:

• Did the problem come on suddenly, or gradually?
• Was it within the first 6 months of life, or did it occur later?
• Is it always the same eye affected, or does it change eyes?
• Is the amount of pull small, medium, or large?
• Is it always there, or only sometimes?
• Has anyone in your family had strabismus?

What are the treatments for strabismus?

There are various treatments for strabismus. Your eye doctor will talk to you about which options are best for your specific condition. Treatment options include:

• Eyeglasses or contact lenses: If you have untreated refractive errors, wearing corrective lenses can help keep your eyes straight, as it reduces the effort your eyes have to put into focusing.
• Prism lenses: These are a special type of lens that bends the light entering the eye, reducing double vision.
• Orthoptics (eye exercises): These exercises can be helpful for some types of strabismus, especially convergence insufficiency (a type of exotropia).
• Medications: Eye drops, ointments, or injections of botulinum toxin type A (e.g., Botox®) can weaken an overactive eye muscle. These treatments may be used in conjunction with or instead of surgery, depending on your condition.
• Patching: If you have strabismus and amblyopia, this method is used to treat it. It can also help control strabismus by improving vision.
• Eye muscle surgery (strabismus surgery): This surgery changes the length or position of the eye muscles to align the eyes properly. This is done under general anesthesia, using dissolvable stitches. Sometimes, adults are offered a procedure called adjustable strabismus surgery. In this, the position of the eye muscles is adjusted after surgery.

You will need to see your doctor again for follow-up appointments to see how you are responding to the treatment. The doctor will make any necessary adjustments.

What will the situation be like after treatment? What is the outlook?

If your child has strabismus, early diagnosis and treatment can help them achieve excellent vision and depth perception . Treatment can also prevent vision loss.

However, even if you are an adult, strabismus can be treated at any age . So don't give up hope.

Is there a way to prevent strabismus?

No, strabismus cannot be prevented. However, if you suspect you have strabismus, you can ask your child's doctor to run some tests and identify any eye conditions early .

If you are an adult and notice any problems with your vision, especially if you have had a stroke or an eye injury, be sure to see an ophthalmologist.

For children and adults alike, it is very important to see your doctor according to the examination schedule recommended by your eye doctor.

Should I see a doctor? When should I go?

If you suspect that you or your child has a squint, be sure to see an ophthalmologist . There are effective treatments for strabismus.

Whether you have an eye injury or notice a sudden change in your vision, you should always see a doctor .

If you have a newborn, you probably spend a lot of time looking at your baby. At first, there may be a lack of focus in the eyes, but this will gradually improve. If you have any concerns about your baby's eyes or vision, be sure to ask your doctor. Your baby doesn't have to be able to talk to be tested for strabismus. Even if your baby has a cross eye - or you do - remember that strabismus is a condition that can be successfully treated . Ask your doctor for more information.

The most important things we need to remember

We've talked a lot about strabismus today. Finally, keep these points in mind:

• Early detection is very important: Pay attention to any changes in the eyes, especially in young children.
• Strabismus is a treatable condition: don't worry, there are various treatments available.
• It is essential to seek medical advice: If in doubt, or if symptoms develop, be sure to see an ophthalmologist.
• There are treatments for adults too: This can be treated at any age, not just in childhood.

Your eyes are a precious asset. And it is your responsibility to take care of your children's eyes as well. I hope this information is useful to you!

` Cross-eye, Misalignment of the eyes, Strabismus, Eye diseases in children, Eye muscles, Double vision, Lazy eye, Eye examination, Eye surgery