Fri. Aug 12th, 2022
    Strabismus (crossed eyes: esotropia, extropia, hypertropia) | Causes, Types, Treatments

    What is strabismus?

    A medical definition of strabismus by doctor Dr Thomas Balmitgère, specialist in ophthalmology.

    Strabismus is characterized by a lack of alignment and coordination of the eyes. Concretely, these “point” in different directions, the axis of vision not being therefore aligned: one of the eyes is “deviated” towards the inside, the outside, the top or the bottom, while let the other eye look ahead. With normal vision, both eyes are looking at the same target at the same time.


    Causes

    There are different causes of strabismus in children and adults and different forms of strabismus:
    • When the squint eye is turned inward, it is called convergent squint.
    • When the squint eye is turned outward, it is called divergent strabismus.
    • When the eye is turned up or down, it is called vertical strabismus.
    • Likewise, the consequences of strabismus vary. If it appears in early childhood, it can lead to amblyopia of one eye (sometimes called “lazy eye syndrome”), which is a defect in the development of vision of the eye, which is most common. often deviated. If it appears later, strabismus can cause double vision (called diplopia).

    Read also: Eye Diseases and Common Eye Problems

    Note it:

    Amblyopia corresponds to a developmental defect in the vision of one of the eyes and, ultimately, poor vision of the reliefs. this visual development defect affects about 2% of children.
    Diplopia is the double visual perception of a single object.
    In all cases, and as soon as the first symptoms appear, it is imperative to consult an orthoptist or an ophthalmologist as soon as possible. Strabismus can be treated and possibly operated on if necessary. Specialists at the Colline ophthalmology center in Lyon receive you to treat this pathology.

    In the rest of this article, find out more about the forms of strabismus and what treatment and surgical solutions are available in children and adults.


    Types of strabismus

    1. Esotropia : convergent strabismus or “squinting eye”

    This pathology is an eye that “squints” inward. It is the most common form of crossed eyes in children. It can appear either at birth – this is called early strabismus or infantile esotropia – or around the age of 2-3 years, and in this case often corresponds to accommodative crossed eyes (strabismus secondary to a visual defect such as hyperopia). This type of strabismus does not cause diplopia, but it can cause amblyopia.

    We will speak of strabismus converge when the two eyes are turned towards each other, towards the inside of the face. We then speak of “squint”. In children, it appears between birth and 5 years.

    Convergent crossed eyes can also appear in adulthood: in this case, it is often linked to paralysis of an oculomotor muscle (the rectus external muscle of the eye). This situation requires carrying out an exploration report to find out the precise cause and suggest an appropriate intervention.

    2. Exotropia: divergent strabismus or exotropia: the eye that “goes outwards”

    Divergent strabismus is the eye that goes outward. It is less common than the previous one but more common than vertical strabismus. It can cause amblyopia in children and may require a workup to find out the cause. In adults, it is often related to paralysis of an oculo-oculomotor muscle (internal rectus muscle) and also requires an exploration assessment.

    3. Hypertropia

    Hypertropia is a condition of misalignment of the eyes (strabismus), whereby the visual axis of one eye is higher than the fellow fixating eye.

    4. Intermittent

    Eye fatigue can be responsible for this defect. In this case, it can be healed by its own.

    5. Acute

    Acute strabismus is characterized by seeing two images of the same object at the same time. This is diplopia.

    6. False strabismus in babies

    It is not uncommon to see squint in babies. “It is then a convergent strabismus of the two eyes which lasts a few seconds. On the other hand, the observation of a permanent unilateral strabismus should promptly consult an ophthalmologist regardless of the child’s age. under 3 years of age it may be retinal cancer, the early diagnosis of which is essential to preserve the child’s vision, eye and life.

    Treatment of strabismus in children and adults: rehabilitation and surgery

    There are several solutions to treat crossed eyes: first, in children, rehabilitation of amblypia should be performed. In certain specific cases, an operation may be carried out. In children, surgery should not be considered for 4-5 years.

    1. Optical correction

    In children, rehabilitation for amblyopia
    In children, it is first necessary to look for a possible abnormal vision (amblyopia) and to know the power of the eye (myopia, hyperopia, etc.). For this, the specialist will perform an examination using eye drops that relax the muscle allowing accommodation (“autofocus” of the eye): it may be atropine or skiacol.

    The ophthalmologist will also do a complete eye exam to look for an abnormality. An optical correction by glasses will be prescribed, which will often make it possible to at least partially correct the strabismus.

    2. Mask on 1 eye

    In addition, a treatment by “mask” on one eye – called occlusion – may be necessary in the event of detection of amblyopia: the principle is simply to apply a mask on the stronger eye to force the weaker to work.

    In certain cases of intermittent divergent strabismus, orthoptic rehabilitation may be prescribed: this will be the case in particular if the patient has to make an effort to realign his eyes in the same direction.

    Detection and treatment in adults

    In adults, a neurological or orbital abnormality or a general pathology may be the cause of crossed eyes. The practitioner will begin with an examination to detect the cause in order to offer treatment or support. In the event of double vision (diplopia), a prism to compensate for the deviation may be prescribed to improve diplopia.

    3. Strabismus surgery: an operation considered when the correction is not enough

    In children, when the optical correction does not completely correct the strabismus, an operation may be offered. Likewise, in adults, in the absence of spontaneous recovery from diplopia, surgery will be recommended.

    In all cases, operations to correct strabismus are performed by acting on the oculomotor muscles (this is either to strengthen or weaken them in order to refocus the eyes). These operations are performed under general anesthesia, in an outpatient department. They last between 30 and 45 minutes. They do not leave scars on the skin (the surgeon goes directly through the conjunctiva). The intervention often requires a 7-day work stoppage and an interruption in sports activities for 3 to 4 weeks.

    Anti-inflammatory and healing treatment is prescribed postoperatively, usually for a period of one month. The final result is obtained in one to three months. Sometimes a second surgery may be necessary to get the desired result.


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    Sources: PinterPandai, Optometrists NetworkBaushMedline PlusGP OnlineAmerican Association for Pediatric Ophthalmology and StrabismusAlamyNCBIUT HSC LibrariesHistophSelect Specs

    Photo credit: www.myupchar.com / Wikimedia Commons