Strabismus can have many different causes and can vary from person to person. It may be attributed to problematic pregnancies, premature birth, incubator care, neurological disorders, febrile illnesses, head trauma, accidents, falls, surgeries, refractive errors (myopia, hypermetropia, astigmatism), lazy eye, diabetes, and hypertension, or it can also be observed as hereditary. If there is a family history of eye misalignment, the likelihood of it appearing in children is high.
Symptoms of Strabismus
As with all conditions, early diagnosis of strabismus is very important. Therefore, routine eye exams for infants and children should not be skipped, and their behaviors should be observed. Strabismus in infants and children may initially present with the child turning their neck in a different direction while looking to the side. Additionally, symptoms may include watering of the eyes, pain, diplopia, headaches, loss of parallelism in the eyes, blurred vision, and loss of three-dimensional vision, many of which can only be understood during a medical examination.
Who can be affected by Strabismus?
Strabismus is more common in individuals with a family history, lazy eye, or high refractive error. For those experiencing strabismus due to muscle paralysis, especially in adults, it may generally result from conditions such as high blood pressure, diabetes, vascular diseases, or head trauma. Some types of strabismus can also be congenital. High hypermetropia, myopia, or astigmatism can cause misalignment. Sometimes, strabismus can accompany and progress with specific conditions; (Down Syndrome, Brown Syndrome, Apert Syndrome, Trisomy 18 syndrome, Noonan Syndrome, Hydrocephalus, etc.). There is no correlation between the occurrence of strabismus and age or gender.
Strabismus in Infants
This condition can be observed in infants in two ways; congenital strabismus and acquired strabismus (squint).
Infants may also experience pseudo-strabismus as their nasal bones will not yet be formed in the first six months. To distinguish this, an eye doctor should be visited after the first six months. If there is congenital strabismus, surgery is performed when the child reaches one and a half years of age.
In cases of acquired strabismus, glasses and eye patches are tried first. If strabismus persists after two examination periods, surgery is performed. Surgery in infants does not differ from that in adults. This surgery is performed under general anesthesia and takes approximately 1 hour.
Is Strabismus Normal in Infants?
Strabismus in newborns is considered normal for a period, but it is expected to resolve after six months. The misalignment may be intermittent or continuous. Families should monitor closely, and if strabismus in one or both eyes persists, they should consult a specialist without delay. Delays may lead to permanent and more serious conditions. The treatment of strabismus, known as squint in layman's terms, is much more successful with an early diagnosis.
Strabismus in Adults
There can be many reasons for strabismus in adults. These include food poisoning, Guillain Barre Syndrome, brain injuries, brain hemorrhages, diabetes, high blood pressure, trauma to the eye, poisoning from marine animals or insect bites, refractive errors, and paralysis.
Strabismus Exercises
The aim of strabismus exercises is to correct the balance disorders in the muscles. Different movements are given to work the strong and weak eye muscles differently. This serves as a form of physical therapy. Due to the focus and misalignment in different directions, the images may not fuse, but these exercises help achieve image fusion. The eyes see in three dimensions regularly, but this is disrupted in strabismus, leading to a loss of depth perception. Exercises are used to eliminate the image discrepancy and maintain balance.
In strabismus exercises, applications are performed with specific materials. Thus, harmony between the weak and the healthy eye is achieved. This treatment is attempted with both children and adults experiencing strabismus. If progress is not made, surgical intervention is the last resort.
Strabismus Test
Vision tests first diagnose the patient's vision problems. If the existing strabismus is due to refractive errors, correcting this error is prioritized. The degree of strabismus is determined through vision tests. Tests conducted for strabismus include a basic squint test, cover test, and cover-uncover test.
Treatment for Outward Eye Deviation (Exotropia)
Exotropia, known as the outward deviation of the eye, is the most common type of strabismus in children, although it can also be seen in adults. It typically presents intermittently, initially mild but increases over time. It can be noticed when a child instinctively closes the deviating eye in bright or excessively well-lit environments. Intermittent exotropia becomes more pronounced, especially when the child is tired, distracted, or feverish. If the deviation is large enough and frequent, it should be treated.
The main aim in treatment with glasses is to align the patient's eyes as much as possible and enhance visual acuity. This treatment can partially prevent and control the deviation.
If glasses are ineffective and outward deviation is constant and pronounced during the day, interfering with social life, surgical treatment is considered. For this condition treatable by surgery, determining the extent of surgical correction is essential. In this surgery, recurrent deviation may occur due to insufficient correction. Therefore, accurately measuring the deviation angle is critical for surgical success.
Can Strabismus be Corrected with Glasses?
Some types of strabismus occur due to refractive errors and can be treated with glasses. As usage continues, the eye misalignment corrects.
Frequently Asked Questions
Why Does Strabismus Occur?
Strabismus, medically referred to as "squint", is an eye disorder where both eyes cannot focus on the same point. This situation can result from transmission disorders in the nerves managing eye muscles, muscle imbalances, or refractive errors requiring glasses. Especially in childhood, high-grade hypermetropia can make eye focusing challenging, leading to inward deviations. In adults, traumas, nerve paralysis, diabetes, thyroid diseases, and neurological disorders can lead to sudden onset strabismus. Without accurately identifying the underlying cause of strabismus, beginning treatment may not yield sufficient long-term results.
What are the Types of Strabismus?
Strabismus is a problem caused by the inability of the eyes to align parallelly. This condition is categorized into types based on the direction of eye deviation. One of the most common types is inward deviation, where one eye turns toward the nose. In outward deviation, the eye moves towards the ear. In rarer cases, an upward or downward deviation occurs where one eye shows a vertical positional disorder compared to the other. Some types of strabismus may develop without a neurological cause, while others are due to the influence on the nerves controlling eye muscles. In paralytic strabismus cases, eye movement can be severely restricted. Accommodative strabismus is common in children and usually associated with high hypermetropia. Correct classification is crucial for treatment planning.
What is the Purpose of Eye Exercises?
In strabismus treatment, eye exercises can help the eye muscles work more effectively, especially in certain types. These exercises aim to improve the focus of both eyes simultaneously. They can be quite effective, particularly in convergence insufficiency, which is a near-distance focus issue. Although exercises may not be fully curative by themselves, they play a supportive role when combined with glasses, prismatic lenses, or surgical treatment. Especially in children, visual exercises gamified can prevent permanent misalignments and aid visual awareness development. For exercises to be effective, they should be planned with the guidance of a specialist physician or orthoptist.
How is Strabismus Surgery Performed?
Strabismus surgery is conducted to realign the eye muscles. During this procedure, the eyeball is not removed; instead, the attachment points of the muscles controlling eye movement are rearranged. The length of muscles may be shortened or repositioned to a more balanced position. The operation is generally performed under general anesthesia, and its duration varies according to the severity of the squint, averaging around 1 hour. Postoperative recovery is quick. In the first few days, there may be slight redness, a stinging sensation, and watering of the eyes. The target post-surgery is to achieve parallel alignment of the eyes and eliminate complaints such as double vision. Not all types of strabismus are suitable for surgery, so the decision for surgery should be thoroughly evaluated.
Why does Strabismus Occur in Children?
Strabismus in children is most commonly due to congenital muscle imbalances or high refractive errors. Deviations that start before six months are typically congenital. If a deviation is noticed after two years, it often develops due to vision problems such as high hypermetropia. In such cases, the use of glasses can correct the deviation. Strabismus in children is not merely a cosmetic problem; it can adversely affect visual development, leading to amblyopia. Therefore, early diagnosis, regular eye examinations, and an appropriate treatment protocol are crucial. The progression of strabismus in children can be prevented with glasses treatment, occlusion therapy, prismatic lenses, or surgery if necessary.
What Causes Sudden Strabismus?
Sudden strabismus can be a sign of a rapidly developing health problem, especially in adults. Nerve paralysis, cerebral vascular diseases, traumas, or tumors can cause sudden onset strabismus. If sudden strabismus is accompanied by symptoms like double vision, dizziness, or balance problems, it necessitates urgent medical evaluation. In children, muscle damage due to trauma or certain neurological conditions can lead to sudden deviations. In every case, a detailed neuro-ophthalmologic evaluation should be conducted, and identifying the underlying cause is essential for effective treatment.