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What is Strabismus?
Strabismus, often referred to as “crossed eyes” or “lazy eye,” is a common visual disorder affecting millions worldwide. This condition disrupts the normal alignment of the eyes, causing them to point in different directions. Strabismus can manifest in various forms and degrees and typically develops in childhood. Left untreated, strabismus can lead to multiple visual impairments and even impact an individual’s self-esteem and quality of life. Adult-onset strabismus is due to neurological causes or can result from childhood strabismus.
In strabismus or squint, 1 or both eyes deviate inwards or outwards and appear to be in nonalignment towards the direction of the focused object. It can be due to refractive error, binocular fusion abnormalities, or neuromuscular anomalies of ocular movements.
If diagnosed and treated early, strabismus has an excellent prognosis. Treatment is usually by refractive error correction, orthoptic exercises, occlusive patching, topical medications, and extraocular muscle surgery.
Symptoms
Treatments
Precautions
Symptoms
- Eye misalignment: One eye appears turned inwards, outwards, upwards, or downwards compared to the other.
- Reduced visual acuity: Strabismus can lead to decreased vision due to misalignment, causing amblyopia.
- Double vision: Misalignment can result in the brain receiving two different images from each eye.
- Amblyopia: Known as “lazy eye,” it involves significantly reduced vision in one eye.
- Neonatal ocular misalignments: Occasional eye deviation in newborns, typically resolving by 4 months.
- Other symptoms: Eye strain, headaches, and difficulty judging distances may also occur.
Early identification and treatment are vital to prevent long-term complications.
Treatments
Strabismus treatment typically involves surgical interventions aimed at restoring proper ocular alignment, which can be classified into three main categories:
- Weakening Procedures: These techniques reduce the strength of the misaligned muscles, including recession, posterior fixation (Faden procedure), marginal myectomy, and myectomy.
- Strengthening Procedures: These methods enhance the pulling force of the muscles to achieve alignment, such as resection, advancement, double-breasting or tenoplication, and cinching.
- Vector Adjustment Procedures: These surgeries alter the direction of muscle action for alignment, including transposition procedures like Hummelscheim, Jensen, O’Connor, Knapp, Callahan, Peter, and Helveston techniques.
Precautions
- Early evaluation: Prompt assessment by an ophthalmologist, followed by thorough evaluation by a pediatric ophthalmologist and strabismologist.
- Multidisciplinary approach: Involvement of various healthcare professionals and educators.
- Skilled screening: Proficient screening for strabismus and prompt identification of risk factors.
- Specialized skills: Possession of relevant skills and knowledge by each team member, including diagnosis and treatment techniques.
- Effective communication: Regular meetings for sharing insights and transparent communication with patients and their families.
- Seamless care coordination: Maintenance of detailed records and open communication among healthcare providers to ensure consistent care.
Types of Pseudostrabismus
Before Surgery
During the Surgery
After the Surgery
Before Surgery
- The patient undergoes a thorough examination to assess their ocular alignment, visual acuity, refractive error, and any associated conditions like amblyopia. This evaluation helps determine the appropriate surgical approach and ensures that any underlying issues are addressed.
- Patients and their caregivers are educated about the surgery, including its purpose, risks, and expected outcomes. They are also informed about postoperative care and what to expect during recovery.
- Patients are given specific instructions to follow before surgery, such as fasting for a certain period of time, discontinuing certain medications, and arranging for transportation to and from the surgical facility.
- For pediatric patients especially, psychological preparation is important to alleviate anxiety and fear about the surgery. Child life specialists or psychologists may be involved to help prepare the patient emotionally.
During the Surgery
- The surgical team, including the ophthalmologist, anesthesiologist, and nursing staff, coordinates to ensure all necessary equipment and personnel are ready for the procedure.
- On the day of surgery, patients arrive at the surgical facility on time and follow any specific preoperative instructions provided by the surgical team.Patients may have a family member or friend accompany them to the surgical facility for support and assistance.
- Patients provide informed consent, indicating their understanding of the procedure and their agreement to proceed with surgery.
- Anesthesia options are discussed with the patient, and the appropriate anesthesia method is chosen based on individual needs and preferences.
After the Surgery
How you prepare for Strabismus Surgery
- Care Instructions: Patients receive detailed instructions on medication usage and eye care.
- Complication Monitoring: Close monitoring for signs of infection or inflammation is essential.
- Eye Protection: Protective eyewear may be advised to prevent injury during healing.
- Rest and Limitations: Patients are advised to rest and avoid strenuous activities.
- Follow-up Appointments: Scheduled visits with the ophthalmologist ensure proper healing.
- Rehabilitation: Patients may receive exercises to improve eye coordination.
- Patience and Expectations: Full benefits of surgery may take time, requiring realistic expectations.
Strabismus FAQs
Is strabismus surgery the only treatment option for an eye turn?
Strabismus treatment options depend on the type of strabismus— direction of eye turns, angle of deviations, the presence of convergence insufficiency, double vision, or amblyopia (lazy eye), etc.
Does the age of the patient matter?
Age does have an impact on whether surgery is appropriate.
Early occurring constant strabismus is the one type of strabismus which might need early surgery to eliminate the eye turn.
For other types of strabismus, especially intermittent, don’t allow a surgeon to rush you into surgery based on statements about age.
Which doctor should I consult for squint?
You should consult an ophthalmologist (eye doctor) who has specialized in squint.
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