Strabismus is a visual condition in which the eyes are not aligned in the same direction. The majority of the strabismus conditions develop during infancy or childhood. However, strabismus can begin in adulthood. When strabismus is acquired as an adult, the person must be evaluated to discard conditions that could be causing it, such as diabetes mellitus, hypertension, uncontrolled thyroid hormone, neurological conditions, intracerebral tumor, aneurysms, and head traumas, among other conditions.
Congenital strabismus can manifest for the first time in adults when certain conditions are present, such as upper oblique muscle paralysis. In adults, the main symptom and the most disturbing, is experiencing double vision that can be neutralized by placing the head in unnatural positions.
In the child, strabismus produces indistinctively a competence between both eyes where one eye does not develop adequate brain connections to produce normal vision. In rare occasions this can be present in both eyes. This is what is commonly known as amblyopia or lazy eye. Just like strabismus, any other condition that occurs during the critical visual development stage and that interferes with the process that allows the images from both eyes to register clearly and simultaneously in the brain and within perfectly corresponding spaces between one eye and the other will produce a lazy eye or amblyopia. In addition to strabismus, there are other conditions that cause a lazy eye, such as drooped eyelids, tumors in the eyelid or orbit (the cone shaped bone that houses the eye) and cataracts, among others.
There are few symptoms of strabismus in children. Given the plasticity of the child’s brain, children can ignore the image of a deviated eye producing what is known as a “lazy eye”. Treatment of strabismus is very effective. The great majority of the cases are resolved with surgery or eyeglasses. Visual therapies are questionable scientific treatments that do not resolve strabismus.Only in very specific cases can visual exercises with prisms (triangular crystals) be performed to diminish problems of exaggerated visual effort.
It is important to call attention to refractive problems such as different measurements between the eyes, astigmatism, myopia and farsightedness that can cause a lazy eye in a child who, visually speaking, seems completely normal and behaves normally. This is why it is never too early to have the child undergo an ophthalmic test.
Commonly, strabismus surgery is an ambulatory surgery in a hospital operation room. Pediatric patients always require general anesthesia; whereas, many adults can undergo the surgery with local anesthesia and sedation when the surgery is limited to one eye. When both eyes must undergo surgery for strabismus, general anesthesia is required. The surgeon makes two small incisions in specific area of the muscle of the eye and proceeds to reposition the muscle by manipulating the tendon.
Strabismus surgery requires a 5-day recovery period. The biggest discomfort is the sensation of having something in eye for a few days. Patients who have had strabismus since childhood and who have surgery to correct the deviation can experience transitory double vision which usually goes away in a period of 2 to 3 weeks.
Dr. Pou has a subspecialty in Pediatric Ophthalmology and Strabismus in children and adults from the University of Michigan in Ann Arbor.
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