Strabismus and Child Eye Health

What is Strabismus?

Both eyes lose their parallelism with each other. There are 6 extraocular muscles in each eye. Lack of strength or excessive strength in one or more of them is the cause of slipping in the eyes. While one eye looks straight, the other can shift inwards, outwards, upwards or downwards. In some cases, slippage is present in both eyes.

The shift in the eyes may be permanent or temporary depending on the cause of strabismus. The incidence of strabismus is approximately 4 per cent and is seen with the same frequency in boys and girls.

What are the Symptoms of Strabismus?

• Loss of parallelism in the eyes.
• Pain in the eyes, watering,
• Double vision, blurred vision, loss of three-dimensional image,
• The head or face is turned to one side, the chin is lifted, the head is tilted forwards and the eyes look upwards.

What are the Symptoms of Strabismus in Adults?

• The most common symptom of strabismus in advanced ages is double vision.
• Symptoms such as pain in the eyes, headache, constant head tilt may be present.
• Children and adults with outward eye shift prefer to close one eye under sunlight.

What are the Risk Factors in Strabismus?

• Those with strabismus in the family,
• Those with a history of preterm labour,
• Those who had a febrile illness with convulsions at a young age
• Those with consanguineous marriages
• Those with a history of trauma (falling from a height, hitting the head)
• The problematic pregnancy period can be counted.

What are the Diagnosis and Examination Methods in Strabismus?

• Assessment of vision. In our hospital, a special paediatric refraction unit (Plus Optix device) is used for children aged 6 months - 4 years.
• The direction of the slide, when it started,
• Determination of slip degree with prisms and synoptofor device,
• Hess curtain examination: important in strabismus due to eye muscle paralysis,
• Hirshberg test: evaluation of the degree of slippage in non-fixation patients by corneal light reflex,
• Stereopsis examination: determination of depth perception (three-dimensional vision).

Childhood Early Diagnosis

It is very important to have the first examination at the age of 1 year at the latest;

• Eyelid drooping, nystagmus (involuntary eye movements) can be diagnosed early in this period and treatment can be started.
• Congenital onset cataract, congenital eye pressure or disorders in the mesh layer of the eye can cause permanent vision loss within 2-3 months.
• Examination between 6 months and 1 year of age is especially important for the detection and treatment of strabismus. After 6 months, persistent slips require treatment.
• In the later period, even if there is no complaint, examinations are important at the ages of 3-4 years and in the pre-school period.

How is strabismus treated?

• Optical Treatment: Some strabismus is due to refractive error and can be corrected with glasses.
• Orthoptic Exercises: It is applied to increase the ability to see with both eyes and the sense of depth.
• Medical Treatment: It is a treatment using mydriatic and myotic drugs.
• Surgical Treatment: The aim is to correct the misalignment, provide binocular monocular vision and achieve an aesthetically good appearance.

It is applied for slips from birth or slips that occur later but cannot be corrected with spectacles.

How to treat strabismus in adults?

• Eye Exercises: It is used in the treatment of special conditions called convergence insufficiency, such as inadequate functioning of the eye when reading or working.
• Prism Glasses: It is used in the treatment of small slips. It reduces double vision.
• Injection ( Botulinum toxin): It is based on the use of a drug that paralyses the muscle into which it is injected for several months. It is a method that is useful in selected cases.
• Operation: It is the most commonly used treatment method at all ages. It can be performed under local anaesthesia in suitable cases. The surgery can be performed for cosmetic reasons, to reduce double vision, to enable the eyes to be used together, to reduce the pain in the eyes.

Amblyopia - What is lazy eye?

Lazy eye, which is called amblyopia in medicine, is a decrease in visual acuity by 20% or more in both or one of the eyes. Its prevalence in the society varies between 2-4%.

Vision is a skill that the brain learns from birth. If there is a defect in the transmission of visual stimuli to the brain due to congenital or acquired eye disorders (cataracts, strabismus, hyperopia, etc.), lazy eye may develop during infancy and childhood when vision develops rapidly. Prevention of lazy eye and achievement of binocular vision (use of both eyes together) is of critical importance especially in the first two years when the nervous system is still flexible. Therefore, the earlier treatment is started, the better results can be obtained. Especially those with a family history of lazy eye or strabismus should have a complete eye examination by an ophthalmologist before the age of 3. However, even if there is no complaint or risk factor, routine eye examination by an ophthalmologist is required for everyone at the age of 3-4 at the latest.

How to treat lazy eye?

In the treatment of lazy eye, intervention for the cause is essential. Firstly, conditions such as droopy eyelids and cataracts that prevent vision should be treated. Other treatment options are respectively:

• Eyeglass treatment: Refractive defects in the eye, which are often the cause of lazy eye, should be corrected by using glasses and, if necessary, contact lenses. This basic approach is sufficient in most cases.
• Closure treatment (Full, partial): It is based on full or part-time closure of the well-sighted eye. In recent studies, it has been shown that 6 hours of closure in advanced lazy eye and 2 hours of closure in mild to moderate lazy eye in the 3-7 age group is sufficient in most cases. Working with nearby targets during closure therapy increases the success of the treatment. In general, children respond positively to closure until the age of 12.
• Penalisation treatment: It is divided into atropine penalisation or optical penalisation. For this purpose, 1 drop of 1% atropine is instilled in the well-sighted eye every day or 2-3 days a week in the morning. While the refractive error of the patient's eye is corrected in the best way in the eye with lazy eye, and even near vision is increased with the addition of + glass; less correction is made in the healthy eye.
• CAM treatment: It is applied in a hospital environment as 10 sessions every day of the week. It is also applied in our hospital. Studies have shown that CAM treatment gives similar visual results with standard closure and close-range occupations.

Until what age should lazy eye treatment be continued?

Even if full vision is achieved in both eyes as a result of lazy eye treatment, lazy eye may recur after the treatment is stopped. For this reason, children with lazy eye should be followed up until the age of 10-12 and if necessary, they should receive maintenance treatment (to preserve vision).

What is Tearing in the Eye and Tear Congestion?

The most common cause of watering and burring in the eye is blockage or stenosis of the tear ducts. When the root of the nose is pressed, inflammatory fluids come out through the hole in the eyelid. This causes distress for the parents during the first year of life, but usually after this period the canal opens and the child's complaints disappear. During this period, massage of the nasal root is recommended to facilitate the opening of the canal and antibiotic drops are recommended during periods of burring.

If the canal is still not opened at the end of one year of age, a procedure called probing can be performed under general anaesthesia. This procedure can be repeated one more time if it fails the first time. If the canal is not opened despite this, surgical intervention is required after 3-4 years of age.

You can reach our hospital for all kinds of issues about eye health, you can get detailed information about your eye problems and learn the process information for treatment.

Prepared by the Editorial Board of Göz Vakfı Hastaneleri.