Re-operation strabismus – when is it necessary?

Strabismus is a disease that is not only an aesthetic problem. If left untreated, strabismus can have serious consequences for a child’s health and development. One of the methods of treatment is surgery. Unfortunately, such treatment is not always effective and brings the expected results. When may surgery be necessary?

What is strabismus?

Strabismus is a disease that consists in the non-parallel alignment of the eyeballs. Most often, strabismus is associated with various visual disturbances in one or both eyes. Today strabismus is already referred to as cross-eyed disease to emphasize that it is not only a cosmetic defect.

When determining the type of strabismus, different classifications can be used. There are, among others, split into:

1. one-sided strabismus – this means that only one eye is squinting;
2. strabismus – this means that the eyes are strabismus alternately.

If the direction of the eye deviation is taken into account, the following should be mentioned:

1. convergent strabismus – the eye goes towards the nose;
2. divergent strabismus – the eye goes towards the temples;
3. strabismus upwards – the eye goes towards the forehead;
4. strabismus downwards – the eye goes towards the chin;
5. oblique strabismus.

It should also be remembered that strabismus can be divided into:

1. hidden strabismus – it is an imbalance of the muscle tone of the eyeballs. In the case of binocular vision, the strabismus is invisible. It can only be noticed when the squinting eye is covered. Immediately after exposure, the strabismus is visible, but the eye immediately returns to its correct position;
2. open squint – means that the squinting eye follows the healthy eye;
3. open squint not accompanying, the so-called paralytic – the eye movements are abnormal in this case, the eyeball is unable to move towards the affected muscle or the movement is limited. One or both eyes may be affected.

Moreover, it should also be borne in mind that the angle of the strabismus can be constant or variable.

Check: What are the disorders of the position and movement of the eyeballs?

What is the effect of strabismus on a child’s development?

Untreated strabismus has a serious impact on a child’s development. In a few months old infants with overt unilateral strabismus, images from the affected eye are suppressed in the brain. Consequently, this eye develops hypnotic and complete loss or underdevelopment of the central retinal fixation. However, these problems only affect the affected eye.

If a child is diagnosed with binocular disorders, the risk is lack of stereopsis (spatial vision), image fusion and simultaneous perception. In addition, the images are confused due to the non-parallel alignment of the eyes to each other. The child sees double due to incorrect retinal correspondence.

Alternating strabismus causes stimuli to be suppressed time and time again in the other eye. As a result, no understatement develops in any of the eyes, but there is no retinal correspondence.

Due to the complications mentioned above, it is advisable to start treating strabismus as early as possible.

Check: Methods of treating strabismus in children

What are the causes of strabismus?

The causes of strabismus include:

1. refractive errors;
2. diseases of the muscles responsible for the movement of the eyeball or the nerves that innervate these muscles;
3. genetic factors;
4. diseases of the central nervous system;
5. diseases of the eyeball or the eye socket itself.

The causes of strabismus can also be idiopathic and therefore unknown. It also happens that vision or blind eyes appear in the squint.

How often does strabismus occur?

Contrary to appearances, strabismus in various forms occurs quite often. In the case of hidden squint, statistics show that it may affect up to 50% of people. Accompanying open squint occurs in about 4-5% of children. Accompanying strabismus is rare in adults. It most often appears in people who have been neglected to treat strabismus in childhood. Paralytic strabismus is much more common in adults. Children are less likely to be affected.

Check: Zez – when to see a doctor?

What should you do when symptoms appear?

Strabismus is always a pathological condition and you should visit an ophthalmologist as soon as you notice that your baby’s eyes are misaligned.

The ophthalmologist will quickly diagnose the type of abnormality. The simplest method is to cover the fixation eyes while looking straight ahead. During the examination, the ophthalmologist observes the eye movements. If you see eye movement as the eye is exposed, it may indicate hidden strabismus.

In children with overt strabismus, movements of the exposed eye are observed when the other eye is covered, i.e. when the eye is exposed, it must fixate. In addition, the ophthalmologist checks the symmetry, range of eye movements, possible refractive errors, visual acuity testing, and also determines the angle of strabismus. In addition, the ophthalmologist immediately checks for other visual disturbances and performs an examination of the anterior segment and the fundus of the eye.

Check: Strabismus correction in children – what are the effects?

How can strabismus be treated?

There is no need for treatment for hidden strabismus that does not cause any discomfort. However, if the patient complains of eye pain, headache, or has double vision, the ophthalmologist may recommend prismatic glasses. In this case, botulinum toxin can also be used to reduce muscle tension. If hidden strabismus is large, it can become overt and then a quick operation is necessary. The operation is also necessary in the case of accompanying strabismus with a large angle, vertical or oblique strabismus.

Among other treatments, it is also recommended to wear glasses constantly, cover the healthy eye, as well as rehabilitation exercises.

Is it possible to cure strabismus completely?

The early treatment of strabismus gives a greater guarantee of complete recovery. However, this requires a combination of different treatments at the same time and close cooperation between the parents or guardians of the child and the doctor. Even after treatment is finished, eye check-ups may be necessary.

When is another strabismus surgery necessary?

Strabismus operations are quite complicated and have different course. During these periods, the effect of certain muscle groups is weakened or they are strengthened if they are too weak. In addition, other techniques, such as adjustable sutures, can also be used during surgery, which allow you to correct the position of the eyes after the surgery.

However, keep in mind that there is always a risk that the eyeballs will fall back into the wrong position. Before the operation, ophthalmologists often emphasize that it may be necessary to perform even a dozen or so operations to achieve the desired effect.

The knobs can assume an incorrect position both shortly after surgery and after several years. Importantly, the eye can squint in the same direction as in another. It is also worth emphasizing that the angle of strabismus is usually different than before the surgery.

Strabismus most often recurs in the case of vertical and oblique strabismus. Similarly, strabismus returns more often when one eye has been diagnosed with amblyopia, which can be corrected with glasses.

Strabismus most often recurs due to scarring of the tissues during healing. Strabismus can also develop due to various complex neurological processes. They lead to the establishment of a new balance between the muscles that move the eyeballs.

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