In order to start answering questions about strabismus, we must first explain how the eye works. Normally, when you focus on an object, both eyes aim at the same object. This creates an identical image in both eyes, so when these images reach the brain, the brain fuses both images into a single 3-D image. The alignment of the eyes is dependent on the external eye muscles which are 6 muscles for each eye that moves the eye globe to the right, left, up, down, and diagonally.  

What is strabismus?

It is a vision problem where a person’s eyes do not align at the same time when looking at the same object. This condition is common in children but could happen to adults too. In this disease, one or both eyes may be affected, one or both of them may look up, down, right or left permanently or intermittently.  

Why is strabismus a problem?

If a child suffers from strabismus, one or both eyes will send a disturbed image to the brain and since the brain needs two identical images to create a three-dimensional image with the perception of depth. It will discard the blurred image and depend only on one image that originated from the healthier eye. This will create a better image but only 2 dimensional! By time, the brain will learn to neglect the image coming from the less healthy eye, and although it is still working, the brain acts like it is not seeing. Leading to permanent vision loss in an otherwise perfect eye!! This is the visual problem of strabismus; the other problem is the psychological one! Children in schools and sports get bullied and ignored because other kids see them as unfit for their friendship or can’t join the team! This has grave psychological impacts on the affected child and may lead to depression!  

Can strabismus happen in adults?

Yes, even if you had a perfectly normal vision in your childhood, you are still at risk of strabismus or amblyopia in adulthood. But in this case, you complain of double vision not only a lazy eye.  

What causes strabismus?

Strabismus itself doesn’t have a direct cause, but it has many risk factors related to the muscular and neurological function of the extraocular muscles mentioned earlier. These risk factors include:

• Family history: if one or both of your parents, one or more of your siblings had or have strabismus then you are more prone to suffer from it.
• Refractive errors: if a child or an adult has mild to severe uncorrected refractive error (most commonly: farsightedness) then he/she is at risk of strabismus as the affected eye exerts extra effort to concentrate on the object to be able to see it more clearly.
• Other medical problems: patients with genetic, congenital problems like Down syndrome, cerebral palsy, or stroke are at greater risk of developing a crossed eye.
• Muscular weakness: if any muscle of the extraocular muscle has suffered from any weakness due to an intrinsic problem or due to a neurological dysfunction or if it has suffered a direct injury then you are at direct risk of developing strabismus.
• Eye problems: if you have cataract or an eye tumor or underwent eye surgery then you are at risk of strabismus.

 

How does an ophthalmologist diagnose strabismus?

As a rule, 99% of eye problems could be detected by eye examination even if the patient didn’t complain of anything. That’s why getting your child’s vision check regularly can save him/her a lot of hassle and unwanted procedures to treat a problem that could have been avoided! This includes eye examination as early as 6 months if the infant is at a higher risk of developing strabismus. Otherwise, routine eye examination every year is enough. In other cases, the parents are the ones who notice that there is a problem with their child’s eyes like they seem to look in different directions, or the child blinks too much or tilts his head and neck to see a certain object. Visiting a pediatrician or an ophthalmologist with expertise in working with children is mandatory to diagnose strabismus as early as possible. Only the doctor can differentiate between true and false strabismus using special tools and instruments to diagnose the disease and its probable cause! In the case of adults, you will complain of double vision and seek immediate help to avoid complications of strabismus.  

How is strabismus treated?

Treatment of strabismus depends on the age of the patient, the level of activity and the severity of the case. The goal in the treatment of strabismus is to:

• Straighten the axis of the eyes.
• Restore three-dimensional (binocular) vision.
• Usually, the first line of treatment is to wear the appropriate eyeglasses to correct the refractive error (usually farsightedness).
• Other treatment modalities include surgery to correct the muscular problem by strengthening the weak muscle or weakening the opposing muscle.
• Wearing an eyepatch on the strong eye is a good way to force the brain to use the weak eye and learn to receive images from it. Restoring binocular vision by time.
• If strabismus is secondary to cataract, then treating this disease is the best method.

 

What is Magrabi’s advice regarding strabismus?

Strabismus is a functional problem of the muscles of the eye or the eye itself. It is easily diagnosed by observing your child closely and totally reversible if you seek medical help as soon as possible. Although many people believe that having a  lazy eye is a not-so-serious problem but unfortunately if neglected it will lead to vision loss! That’s why Magrabi recommends regular eye examination for your child and yourself especially if you have a family history of crossed eyes or lazy eye.