Amblyopia / Strabismus > Strabismus
Strabismus
Strabismus (also known as an eye turn, wandering eye, crossed eye, or wall eye) is a lack of coordination between the eyes. The eyes cannot work together so they drift apart and look in different directions. This causes the brain to receive double images. If not treated early, strabismus can lead to loss of vision or amblyopia (lazy eye) where the brain suppresses, or ignores one of the images to avoid seeing double. As a child gets older, the likelihood of restoring this vision decreases. Crossed eyes can also have negative implications for a person's self-confidence and social interactions.
Strabismus can result due to the following:
- Improper development of eye muscle coordination in infants and children.
- Brain injury such as trauma, stroke or aneurysm that causes a paralysis of a nerve that controls the muscle.
- Problems with the nerves or muscles that control eye movement.
- Excessive farsightedness (hyperopia) or a large difference between the vision of each eye.
Strabismus Classification
Strabismus is classified by the direction that the "wandering eye" turns.
- Esotropia: eye turns in
- Exotropia: eye turns out
- Hypertropia: eye turns up
- Hypotropia: eye turns down
- Intermittent (ie. when tired or after prolonged reading or computer use)
- Alternating (between right and left eye turn)
Pseudo-strabismus, a fake strabismus, can occur in newborns. A child's eyes may drift in and out of alignment because he has not developed bilateral integration or coordination of his eyes. The eyes usually straighten as the infant's visual system develops. Infants also often have a wide, flat nasal bridge and a fold of skin at the inner eyelid that tends to hide the eye when looking to the side, thus creating the illusion that the eyes are turned inwards. A Developmental Optometrist can easily distinguish a true strabismus from a pseudo-strabismus.
Strabismus is one of the reasons that the American Optometric Association recommends a child's first vision exam is given at 6 months old and yearly thereafter. The following issues caused by Strabismus can occur if undetected early:
- Amblyopia
- Double vision
- Blurry vision
- Ghost images
- Impaired depth perception or 3D vision
- Eyestrain
- Difficulty reading
- Difficulty catching a ball
- Difficulty driving or parking a car
- Impaired ability to judge distances or localize where objects are in space
- Difficulty focusing on visual tasks
- Difficulty focusing on the person you are looking at
The goals of treatment for strabismus are restoring 3-dimensional vision, functional vision, eye alignment and restoring vision to the eye that is misaligned. Treatment options for strabismus include:
- Vision Therapy
- Patching
- Eye muscle surgery
- Glasses which may incorporate prism
- Removing a cataract or incorporating another problem that is contributing to the eye turn
In vision therapy programs, optometrists look at the neurological control system to treat the whole visual-motor system and alter reflexive behavior, which results in a lasting cure. Vision Therapy for strabismus generally consists of either weekly or bi-weekly office based therapy under the supervision of a Vision Therapist and Developmental Optometrist to make sure the procedures are accurately performed and progress is monitored. We also prescribe home therapy to reinforce in-office therapy and accelerate treatment.