Strabismus is the situation that both eyes loss their parallel alignment. It is caused by loss of or increase in the muscle tone of one or more of the six muscles which control the movements of the eye. When one eye is looking straight the other one can slide to the medial, lateral, upward or downward. Under some circumstances sliding can happen in both eyes and strabismus can be seen continuously or temporarily according to the cause. Strabismus can become evident due to different causes.
Early diagnosis is very important in strabismus treatment. When the first ophthalmologic evaluation of the child has fallen behind the scheduled age beyond the esthetic problems in children this situation can cause amblyopia that can last lifelong. Short after the birth and in the early childhood period all children must be evaluated by a pediatric ophthalmologist.
Causes of the Strabismus:
Strabismus can be the result of many problems. Problems in the antenatal period, problematic birth, development of the child, the child’s diseases that he/she has been had can cause strabismus. The genetic inheritance is also possible for strabismus. It increases the risk of having strabismus of the child if it runs in the family.
The Strabismus seen in the childhood period – after 2 years of age – is generally caused by defects in the eye. In a child who has a probability of strabismus, it can be apparent after a fever or trauma such as a fall or a surgery.
The center that controls the movements of the eyes is located in the brain. That is why the paralysis which effects the nerves can cause strabismus also. Strabismus which is seen in the advanced childhood period can be due to this. Accidents, head trauma, fever and hypertension in the older ages and diabetes can cause paralysis in the nerves that control eye movements. In these causes of strabismus, the treatment can be different according to the cause that it is a temporary situation or not. Strabismus, which is a result of nerve paralysis can cause amblyopia in the childhood period and double vision in the older age group, so treatment of the underlying situation is mandatory.
Symptoms of strabismus
- Loss of parallelly of eyes
- Pain
- Headache
- Double vision
- Loss of 3D vision
- Blurred vision
- Tilting of the head or face
Some of the strabismus seen in the early infancy period is pseudo-strabismus. Pseudo-strabismus is a situation which becomes evident due to widening of the nasal bridge or eye lids. A pediatric ophthalmology examination is necessary to differentiate from strabismus.
If sliding is seen continuously in the same eye it points out that vision is weaker in the effected eye and it is important. So, infants and children who has sliding in a significant eye need a pediatric ophthalmology examination as soon as possible.
TREATMENT OPTIONS OF THE STRABISMUS
Treatment of the all kinds of strabismus must be directed to the underlying cause. Surgical correction must be added to the conservative treatments such as eye-glass and closure of the eye. Strabismus is a health issue that can be corrected in each age group.
Eye-glass Treatment:
Some kind of strabismus is due to refractive errors. When the patient starts to use glasses, it resolves spontaneously. Eye-glass is enough for the treatment of this kind of strabismus.
Closure Treatment:
This treatment option is suitable if the patient has amblyopia additionally. When the visual acuity increases the patient can control sliding. It is very important in treatment algorithms.
Orthoptic Treatment:
Orthoptic treatments are targeting to increase the muscle functions of the eye. It is applied to increase the strength of some muscles and seeing ability with both eyes. It increases the sensation of depth by strengthening seeing ability with both eyes. This function of our eyes secure the parallel alignment of both eyes and it is very important in our daily life. People who spend long time periods on working close distance and having problems during driving benefit a lot.
Surgical Correction:
Congenital strabismus needs surgical treatment in the early infancy period (6 months – 1 year). Most of the strabismus become apparent around 2 – 3 years of age and generally a total correction with eye-glasses is possible. When strabismus is unresponsive to treatment with eye-glasses surgical correction is needed. Strabismus surgery is performed under general anesthesia. The induction of the anesthesia is performed by specialized pediatric anesthesiology physicians. With early diagnosis of the strabismus amblyopia can be prevented and 3D vision can be achieved. For this particular reason every child who has a suspicion of strabismus must be seen by a specialized pediatric ophthalmologist in strabismus as soon as possible.
Botulinum Toxin Injection:
Botulinum toxin injection is a treatment option in some strabismus patients. It is effective in strabismus patients due to paralysis, in patients which total correction could not be managed surgically, and in goiter patients who has strabismus. In strabismus due to paralysis double vision is also seen and this situation is complicated for the patient. In these kinds of strabismus general treatment algorithm is to wait for 6 – 8 months for resolve of the strabismus but during this time period botulinum toxin injection can help to improve double vision. Starting treatment in the early period after strabismus become evident, total correction is possible.