Strabismus & Amblyopia (Children)

The difference between strabismus (eye misalignment) and amblyopia (lazy eye)

What causes strabismus in children?

In young children, the two most common types of strabismus are accommodative esotropia, where the eyes cross due to excessive farsightedness, and infantile esotropia, where children are born with the tendency to cross their eyes. Strabismus in children is less commonly caused by head trauma and diseases that affect the brain or nerves that go to the eye, such as tumors, hydrocephalus (water on the brain), or cerebral palsy.

What are the complications of strabismus in children?

In any childhood strabismus, amblyopia may occur. Often called lazy eye, amblyopia occurs when the brain shuts off the image in one eye long enough that the vision is permanently decreased. In most cases, this condition is easily improved if treated early. (See amblyopia topic page)

At what ages does strabismus occur?

Strabismus can begin in infancy, early childhood, or even in adulthood. When strabismus begins in children before 6 years old, double vision rarely occurs because the brain is still able to shut off (or suppress) the vision in the deviating eye. 

Early detection is key

In all strabismus, early diagnosis by a pediatric ophthalmologist (who also deal with adult strabismus) will allow proper treatment. Timely treatment by a trained physician offers the best chance of getting the eyes working together.

Treatment

Normally, the eyes work as a team, aiming at the same spot, providing the brain with the information it needs to create a three-dimensional image. This three-dimensional image is what gives a person the depth perception which helps us in so many daily activities at work, play, and sports. Strabismus means that the two eyes point at different spots (that is in different directions) and the brain sees two different images which cannot be combined, or fused, into a single image. In young children, the brain will then ignore or turn off the image in one eye or the other to prevent confusing double vision.

Almost half of the strabismus we see at the Spokane Eye Clinic can be treated with glasses, prisms, exercises, and patching. It is important to line the eyes up as early as possible so that the brain can develop the best ability to combine or fuse the images of the two eyes into one picture. So if these techniques are not effective surgery will usually be recommended.

Strabismus Surgery

Modern strabismus surgery is done in an outpatient setting and is minimally invasive. The Ophthalmologist makes a small incision in the tissue covering the white of the eye to reach the eye muscles.  Each human eye has six muscles, responsible for moving it in various directions, and typically the surgeon repositions one or more of these muscles, in one or both eyes, to bring the eyes into alignment. Once aligned, the eyes can move together as intended, sending images back to the brain which may be fused into one three dimensional images. This is done in the safety of an operating room with general anesthesia providing complete comfort to the patient.

Recovery time is rapid. Most normal activities can be resumed within a few days. After surgery glasses, sometimes with prisms, and sometimes exercises or patching may be helpful "fine tune" alignment.  Further surgery at a later time is often needed to keep the eyes in good alignment.

As with any surgery, eye muscle surgery has some risks. These include infection, bleeding, excessive scarring, and very rare cases of vision damaging complications. Usually, strabismus surgery is safe and effective.

Other Considerations

Ocular Torticollis

Torticollis is a persistent tipping and or turning of the head, and when it is done to prevent double vision or blurring it is called ocular torticollis. The two most common causes are nystagmus, which is a rhythmic back and forth eye jerking, and some forms of strabismus where the alignment of the eyes is better in some directions or head positions. Modern eye muscle surgery can reduce nystagmus and improve the head position in many cases. Similarly, with careful diagnostic measurements of all of the eye muscles, the ophthalmologist can design strabismus surgery to improve the imbalances between muscles, so that the head tilt or turn is no longer necessary to achieve single vision. As with any eye muscle surgery, it is outpatient with rapid recovery being usual.  Glasses, often with a small amount of prism may enhance the results of surgery.

Read about Strabismus in Adults

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