Strabismus – causes, types, diagnostics. Can strabismus be treated?

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A squint is a misalignment of the eyeballs. It can be physiological in young children. It can occur on one or both sides. When to see a doctor and what is the treatment like?

Zez – what is it?

Strabismus is the most common condition in children. It is normal for a newborn to occasionally wander or cross eyes during the first few months of life. However, by the time they reach 4-6 months of age, the eyes should be properly oriented. If one or both eyes keep wandering, looking up or down – even intermittently – it’s likely due to a condition called strabismus.

When detected early, strabismus is treatable with a variety of safe and effective treatments. For children, it is important that they are treated early – waiting too long or missing treatment entirely can lead to permanent loss of vision.

Strabismus is the misalignment or wandering of one or both eyes inward (called esotropia), outward (exotropia), up (hypertropia), or downward (hypotropia). The condition can be permanent or intermittent, such as when a child is tired or is looking at something closely.

Strabismus can be present from birth or develop in early childhood. In most cases, the cause is unknown, although children with a family history of strabismus are at a higher risk.

Most children are diagnosed between the ages of 1 and 4. Rarely, strabismus develops after the age of 6. If this happens, it’s important to see a doctor immediately, who will then refer your child to a pediatric ophthalmologist and possibly a neurologist to rule out any underlying medical conditions that may be causing the problem.

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Strabismus – causes and risk factors

Strabismus can be caused by problems with the eye muscles, the nerves that carry information to the muscles, or the brain’s control center that guides eye movements. It can also develop due to other general eye conditions or injuries.

Risk factors for developing strabismus include:

1. family history – in people whose parents or siblings have strabismus, the probability of its occurrence is very high,
2. refractive error – People who have a significant amount of uncorrected farsightedness (hyperopia) may develop strabismus due to extra visual focus
3. medical conditions – people with conditions such as Down syndrome and cerebral palsy, or who have suffered a stroke or head injury, are more likely to develop strabismus.

Strabismus can also be caused by:

1. blurred vision
2. uneven stretching of the muscles that control the position of the eyes, causing them to point in different directions
3. paralysis or weakness of the nerve that controls eye movement
4. birth defect of the eyes.

Rarely, strabismus is caused by a type of eye cancer that mainly occurs in young children (retinoblastoma) or an eye injury.

Children are more likely to develop strabismus if they:

1. were born prematurely,
2. parents have strabismus,
3. their mother used drugs or alcohol while pregnant.

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Strabismus – types

Although it might seem that there is only one type of strabismus – when the eyes look inwards – there are different types of strabismus. Here are the most common types of strabismus:

1. ezotropia — characterized in that one or both eyes are turned inward towards the nose. It is the most common type of strabismus and affects 2 to 4% of children.
2. exotropia — this type of strabismus, where one or both eyes are turned outwards towards the ear, affects 1% to 2% of children,
3. hypertropia (hyperopia) – this condition occurs when the eyes are misaligned and the misaligned eye is higher than the other eye. It affects about one in 400 children
4. hypotropia — it can be thought of as the opposite of hypertropia – a misaligned eye is lower than the other eye.

In addition, in which direction the eyes are turning, doctors distinguish individual cases of strabismus and its nomenclature in the case of its occurrence in children. Common classifications include:

1. children’s esotropy – 1 in 50 babies are born with this eye disorder. Cases that do not resolve spontaneously by 4 months of age require treatment,
2. accommodative esotropy – can be the result of severe farsightedness and usually appears after the baby’s first birthday. It usually starts gradually and then this type of strabismus becomes permanent.
3. Pseudostrabismus (pseudostrabizm) – this is the false appearance of crossed eyes. When the eyes are actually crossed or not completely aligned, it is called squint. Pseudostrabism usually occurs in infants and young children whose facial features are not fully developed.

It should be remembered that not every case of strabismus will be easily visible to the naked eye. Talk to your child’s pediatrician if you notice any of the following symptoms, whether your eyes appear crossed or not:

1. squinting or blinking frequently, especially in bright light. This could be a signal that your baby is experiencing double vision,
2. turning or tilting the head. This could be a sign that your child is trying to position an object in his field of view.

Read: Which vision defects can be corrected by laser vision correction?

Zez – diagnostics

An ophthalmologist can diagnose strabismus through a comprehensive eye examination. The diagnosis of strabismus, with an emphasis on how the eyes focus and move, may include:

1. patient history – the ophthalmologist will ask the patient or parent about any current symptoms. In addition, your doctor will note any general health problems, medications, or environmental factors that may be contributing to the onset of strabismus symptoms.
2. visual acuity – an ophthalmologist will measure your visual acuity to assess to what extent your vision is affected. During the test, you will be asked to read the letters on the boards up close and far away. Visual acuity is recorded as a fraction, e.g. 20/40. The top number is the standard distance over which tests are performed. The bottom number is the smallest letter size you could read at 20 feet. A person with a visual acuity of 20/40 would need to approach within 20 feet of the letter, which should be clearly visible from 40 feet away. “Normal” distance vision acuity is 20/20. Your ophthalmologist has other methods of measuring vision in young children or patients who cannot speak or understand the visual acuity test.
3. refraction – an ophthalmologist may perform refraction to determine the correct lens power needed to compensate for the refractive error (nearsightedness, farsightedness or astigmatism). Using a medical device called a phoopter, a doctor places a series of lenses in front of the eyes and measures how they focus light using a hand-held, illuminated device called a retinoscope. Or, the physician may use an automated or manual instrument that assesses the refractive power of the eye without the patient having to answer any questions.
4. alignment and focus tests – the ophthalmologist needs to evaluate how well your eyes focus, move and cooperate with each other. To get a clear, single image of what you are watching, your eyes must effectively focus, move, and work in unison. These tests will look for problems that prevent your eyes from focusing effectively or making it difficult to use both eyes at the same time.
5. fundus examination – Using a variety of testing procedures, your ophthalmologist will look at the inner and outer structures of your eyes to rule out any eye disease that may be contributing to the strabismus. This test will determine how your eyes react under normal visual conditions. For patients who cannot respond verbally or where some of the forces focusing the eyes may be hidden, the doctor may use eye drops. Eye drops temporarily stop the eyes from changing focus during the test.

Using the information obtained from these studies, along with the results of other tests, your doctor can determine if you have strabismus. After the tests are complete, your doctor may discuss your treatment options.

Strabismus – treatment

The main method of treating strabismus is corrective glasses. Glasses can help if strabismus is caused by a child’s vision problems. such as: farsightedness, myopia or astigmatism.

Ophthalmologists also recommend regular eye exercises to stimulate the muscles that control eye movement to work. Exercises are able to improve the eyes and help heal the defect.

In serious cases, corrective surgery is performed. The procedure involves shifting the muscles that control eye movements so that the eyes are properly aligned. This method is used when the glasses are not fully effective and the defect persists.

For the treatment of strabismus, ophthalmologists also use:

1. injections into the muscles of the eye to weaken them, which may facilitate better eye alignment. The effect lasts about 3 months,
2. on the so-called lazy eye methods are used to stimulate it to work, for example: gluing the second, healthy eye.

Strabismus – complications

Untreated strabismus can cause further difficulties, such as:

1. persistent, blurred or double vision
2. lazy eye – the brain begins to ignore signals from the affected eye,
3. embarrassment or low self-esteem.

Surgery can help improve eye alignment, even when strabismus hasn’t been treated for a long time. Unfortunately, vision defects can be permanent if left untreated at a young age, so all visual diseases should be treated as early as possible.