Strabismus
Strabismus (crossed eyes) is a condition in which the eyes do not line up with one another. In other words, one eye is turned in a direction that is different from the other eye.
The condition is more common in children, but it can also occur later in life. In older children and adults, crossed eyes can be caused by a variety of underlying medical conditions, like cerebral palsy or stroke.
Types –
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)
Signs –
If you have crossed eyes, your eyes might point inward or outward or focus in different directions. You might also have:
• impaired vision
• double vision
• decreased depth perception
• eyestrain or headache
Causes –
Six different muscles surround each eye and work “as a team.” This allows both eyes to focus on the same object.
In someone with strabismus, these muscles do not work together. As a result, one eye looks at one object, while the other eye turns in a different direction and looks at another object. When this occurs, two different images are sent to the brain — one from each eye. This confuses the brain. In children, the brain may learn to ignore (suppress) the image from the weaker eye.
If the strabismus is not treated, the eye that the brain ignores will never see well. Most of the time, the problem has to do with muscle control, and not with muscle strength.
Risk Factors –
You’re more likely to develop crossed eyes if you:
• have family members who have crossed eyes
• have a brain disorder or brain tumor
• have had a stroke or brain injury
• have a lazy eye, are farsighted, or have vision loss
• have a damaged retina
• have diabetes
Diagnosis –
Anyone older than four months of age who appears to have strabismus should have a complete eye examination by a pediatric ophthalmologist, with extra time spent examining how the eyes focus and move. The exam may include the following:
• Patient history
• 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).
• Alignment and focus tests
• Examination after dilation (widening) of the pupils
Treatment –
Your recommended treatment plan for crossed eyes will depend on the severity and underlying cause of your condition. If your crossed eyes have resulted from a lazy eye, your doctor may have you wear a patch over your stronger eye to force the muscles of your weaker eye to work harder.
Treatment options include the following:
• Eyeglasses or contact lenses: Used in patients with uncorrected refractive errors. With corrective lenses, the eyes will need less focusing effort and may remain straight.
• Prism lenses: Special lenses that can bend light entering the eye and help reduce the amount of turning the eye must do to look at objects.
• Orthoptics (eye exercises): May work on some types of strabismus, especially convergence insufficiency (a form of exotropia).
• Medications: Eye drops or ointments. Also, injections of botulinum toxin type A (such as Botox) can weaken an overactive eye muscle. These treatments may be used with, or in place of, surgery, depending on the patient’s situation.
• Patching: To treat amblyopia (lazy eye), if the patient has it at the same time as strabismus. The improvement of vision may also improve control of eye misalignment.
• Eye muscle surgery: Surgery changes the length or position of eye muscles so that the eyes are aligned correctly. This is performed under general anesthesia with dissolvable stitches. Sometimes adults are offered adjustable strabismus surgery, where the eye muscle positions are adjusted after surgery.
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