Strabismus is a condition involving the surrounding muscle structure of the eye; due to weakness or muscle coordination, the eyes are misaligned and point in different directions.

• Esotropia: eyes turn, deviate inward towards nose.

• Exotropia: eyes turn, deviate outward away from nose. 

Most common in children, Strabismus affects about 4% of the children in the United States.  Overall, strabismus can occur at any age.  A child will not outgrow true strabismus.

Signs of Strabismus

The signs of strabismus are visible:

• Eye will appear turned or crossed. 
• Noticeable asymmetrical light reflection on the surface of the eyes.
• Bright sunlight may cause children to squint one eye, or
• Tilt their head to use both eyes together.

Strabismus should not be ignored.  If you have concerns or notice these signs, please contact our office for to schedule an examination with one our Ophthalmic Pediatric Specialists:  Dr. Aazy Aaby, Dr. Charles J. Bock, Dr. Daniel R.Holland

Strabismus and Vision Development

The misalignment of an eye affects how the eyes work together.  When one eye is out of alignment, the brain receives two different pictures.  In comparison to normal vision, the brain combines the two pictures from both eyes into a single three dimensional image: binocular, (two-eyed) vision.  This function of normal vision enables depth perception capability.

Comparatively, in young children with strabismus, the brain learns to ignore the image of the misaligned or crossed eye and concentrates on the vision received from the straight or better-seeing eye.  Overtime, a child with untreated strabismus or crossed eye may experience reduced vision in the misaligned eye, or amblyopia.

Amblyopia is commonly referred to as “lazy eye.”
Amblyopia is poor vision in an otherwise normal appearing eye, which occurs when the brain does not recognize the sight from that eye due to misalignment or refractive error( need for glasses) between the two eyes.

Adults with late development of strabismus typically experience double-vision.  This due to the already established neuro-link from both eyes; the brain has already learned to receive images from both eyes and cannot ignore the vision from the turned eye.

Strabismic Amblyopia occurs in nearly half of the children who have stabismus. During early childhood vision development, if the vision in the misaligned eye is consistenly ignored, the eye may fail to develop good vision.  The brain will pay attention to normal images of the straight eye and ignore the image of the turned or crossed eye.

What causes Strabismus?

Strabismus is a condition involving the muscle structure of the eye.  When weakness or lack of muscle coordination is present in the eyes they are unable to work together. Alignment, balance, and focus on a single target requires all the muscles in each eye to work together.

There are six muscles to control eye movement, which surround each eye.  These individual muscles are controlled by the brain.

Children with brain disorders are more commonly effected by stabismus:

• Cerebral Palsy
• Down Syndrome
• Hydrocephalus
• Brain Tumors
• Prematurity

Treatment of Strabismus

Treatment works to straighten the eyes and restore binocular (two-eyed) vision.  Early detection of Strabismus & Amblyopia is critical to ensure proper visual development.  If treatment is delayed or symptoms undiagnosed, amblyopia may become permanent.

Treatment includes:

• A patch used to cover the “good” eye as a way to strengthen the muscles and vision in the weaker eye.
• Eyeglasses prescribed to straighten the eyes.
• Surgery to correct the unbalanced eye muscles. 

Surgery is considered safe and effective for treatment of eye misalignment.  However, it is not a substitute for glasses or amblyopia therapy. Depending on which direction the eye is turning, muscles are detached and repositioned through a small incision in the tissue covering the eye. Glasses may still be required after surgery. *Surgery risks include: infection, bleeding, excessive scarring. Rare complications can lead to loss of vision.

How is Strabismus Diagnosed?

The physicians at EyeHealth Northwest are trained to detect and treat these conditions during an exam. 

We have three Fellowship trained Pediatric Ophthalmologists available for treatment, consultation and second opinions. Dr. Aazy Aaby, Dr. Charles J. Bock, Dr. Daniel R.Holland

Early detection, within the first few years of life, significantly increases the success of treatment and life-long vision result.  While not everyone with strabismus has a family history or relatives with the visual defect, those children who do, have an increased risk for development.  A child will not outgrow true strabismus.

• All infants by six months to one year of age should be screened for ocular health including a red reflex test by a properly trained health care provider such as an ophthalmologist, pediatrician, family physician, nurse, or physician assistant during routine well-baby follow-up visits.

• Vision screening should also be performed between 3 and 3 1/2 years of age. Vision and alignment should be assessed by a pediatrician, family practitioner, ophthalmologist, optometrist, orthoptist, or individual trained in vision assessment of preschool children. Emphasis should be placed on checking visual acuity as soon as a child is cooperative enough to complete the examination. Generally, this occurs between ages 2 ½ to 3 ½. It is essential that a formal testing of visual acuity be performed by the age of 5 years.

For more information, or to schedule an exam, contact us, MyEyeHealth