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Strabismus Information

Learn about this condition, its impact, and our breakthrough treatment approach

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WHAT IS STRABISMUS

Strabismus, commonly known as "crossed eyes" or "wall eyes," is a vision condition in which a person cannot align both eyes simultaneously under normal conditions. One or both of the eyes may turn in (esotropia), out (exotropia), up (hypertropia), or down (hypotropia). The eye misalignment may be constant or intermittent, and may affect one eye or alternate between eyes.

In normal vision, both eyes aim at the same spot and send similar images to the brain, which fuses these images into a single, three-dimensional picture. With strabismus, each eye is looking at a different object, sending different images to the brain. This can cause double vision (diplopia), confusion, and reduced depth perception.

Strabismus affects approximately 4% of the population and can occur at any age, although it is most common in young children. If left untreated, strabismus can lead to amblyopia (lazy eye) and permanent vision impairment.

TYPES OF STRABISMUS

Strabismus is classified by the direction of the eye turn and other characteristics:

  • Esotropia: Inward turning of the eye(s) toward the nose (cross-eyed)
  • Exotropia: Outward turning of the eye(s) away from the nose (wall-eyed)
  • Hypertropia: Upward turning of the eye(s)
  • Hypotropia: Downward turning of the eye(s)
  • Cyclotropia: Rotational turning of the eye(s)

Strabismus can also be classified based on other features:

  • Constant vs. Intermittent: Whether the eye turn is always present or occurs occasionally
  • Unilateral vs. Alternating: Whether the same eye always turns or if the turn alternates between eyes
  • Concomitant vs. Incomitant: Whether the angle of misalignment is the same in all directions of gaze (concomitant) or varies (incomitant)
  • Accommodative vs. Non-accommodative: Whether the eye turn is related to focusing efforts or not

Common specific types include:

  • Infantile Esotropia: Inward turning that develops in the first 6 months of life
  • Accommodative Esotropia: Inward turning related to focusing efforts, often associated with farsightedness
  • Intermittent Exotropia: Outward turning that occurs occasionally, often when tired or ill
  • Duane Syndrome: Limited eye movement, often with narrowing of the eye opening when looking inward
  • Brown Syndrome: Inability to move the eye upward, especially when the eye is turned inward

SYMPTOMS

Signs and symptoms of strabismus may include:

  • Noticeable misalignment of eyes
  • Eyes that don't move together
  • Frequent squinting or closing one eye
  • Head tilting or turning to compensate for vision issues
  • Poor depth perception
  • Double vision (in older children and adults)
  • Eye strain or eye fatigue
  • Difficulty reading or concentrating
  • Headaches
  • Vision loss or decreased vision in the affected eye (if amblyopia develops)

In infants and young children, signs to watch for include:

  • Asymmetric light reflection in the pupils
  • Excessive tearing
  • Covering or closing one eye when looking at objects
  • Tilting or turning the head consistently to look at objects
  • Bumping into objects on one side (indicating poor side vision)

CAUSES AND RISK FACTORS

Causes of Strabismus:

  • Refractive Errors: Uncorrected farsightedness can lead to accommodative esotropia
  • Neuromuscular Conditions: Problems with the nerves that control eye muscles
  • Cranial Nerve Palsies: Particularly affecting the 3rd, 4th, or 6th cranial nerves
  • Eye Muscle Abnormalities: Weakness, injury, or abnormal development of eye muscles
  • Brain or Neurological Disorders: Including stroke, brain tumors, hydrocephalus, or cerebral palsy
  • Genetic Factors: Family history of strabismus increases risk
  • Trauma: Head or eye injuries
  • Medical Conditions: Certain systemic diseases or conditions like thyroid eye disease

Risk Factors:

  • Premature birth
  • Low birth weight
  • Family history of strabismus
  • Uncorrected refractive errors, especially hyperopia (farsightedness)
  • Certain medical conditions (Down syndrome, cerebral palsy, etc.)
  • Previous eye injury or surgery
  • Developmental delays

DIAGNOSIS

Diagnosis of strabismus typically involves a comprehensive eye examination that includes:

  • Visual Acuity Testing: To measure the clarity of vision in each eye
  • Refraction Assessment: To determine if there are refractive errors that require correction
  • Alignment Tests:
    • Cover Test: Covering and uncovering each eye to observe movement
    • Hirschberg Test: Examining light reflections in the pupils
    • Prism Test: Using prisms to measure the amount of misalignment
    • Krimsky Test: Another method to measure the degree of strabismus
  • Ocular Motility Testing: To assess how well eye muscles function and coordinate
  • Accommodative Testing: To evaluate the focusing ability of the eyes
  • Binocular Vision Testing: To determine how well the eyes work together
  • Ocular Health Examination: To check the overall health of the eyes

Additional tests may be performed to determine if the strabismus is related to other medical conditions:

  • Neurological examination
  • Imaging studies (MRI or CT scan) if a neurological cause is suspected
  • Blood tests to check for systemic diseases

STANDARD TREATMENT

Treatment for strabismus varies depending on the type, cause, and severity of the condition. The main goals are to preserve or restore vision, align the eyes, and achieve good binocular vision. Standard treatment options include:

  • Corrective Lenses: Glasses or contact lenses to correct refractive errors, which may help align the eyes, especially in accommodative esotropia.
  • Prism Lenses: Special lenses that bend light to compensate for eye misalignment, especially helpful for small-angle strabismus.
  • Vision Therapy (Orthoptics): Specialized exercises to improve eye coordination, focusing abilities, and brain processing of visual information.
  • Eye Muscle Surgery: A procedure to tighten, weaken, or reposition the eye muscles to better align the eyes. This is often necessary for larger-angle strabismus or when non-surgical methods are ineffective.
  • Patching or Atropine Drops: Used to treat amblyopia (lazy eye) that may develop due to strabismus.
  • Botulinum Toxin (Botox) Injections: Sometimes used as an alternative to surgery or for temporary improvement, by weakening overactive eye muscles.

In many cases, a combination of treatments is most effective. The specific treatment plan depends on factors such as:

  • The patient's age
  • The type and amount of eye turn
  • Whether the strabismus is constant or intermittent
  • The presence of double vision
  • The status of vision in each eye
  • The presence of associated conditions

Early intervention generally yields better outcomes, but treatment can be effective at any age. While many people believe that children "outgrow" strabismus, this is rarely the case without treatment.

OUR APPROACH

Our approach to strabismus treatment goes beyond conventional methods by addressing not just the eye misalignment but also the underlying neuromuscular and visual processing issues. We integrate traditional therapies with innovative approaches to achieve optimal outcomes.

Our comprehensive protocol includes:

  • Detailed functional vision assessment to identify specific deficits in visual processing
  • Advanced vision therapy techniques to improve eye teaming, tracking, and focusing abilities
  • Specialized exercises to strengthen weakened eye muscles and improve neural control
  • Biofeedback and perceptual learning techniques to enhance visual processing
  • Nutritional support targeting neuromuscular function
  • Synergistic therapies that complement traditional medical treatments

While we recognize the value of conventional treatments like corrective lenses and surgery in appropriate cases, our goal is to achieve maximum improvement through non-invasive approaches whenever possible. For patients who have already undergone surgery, our therapies can help optimize results and prevent regression.

Our treatment plans are highly individualized, with protocols tailored to each patient's specific type of strabismus, age, visual status, and overall health.

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REFERENCES

  • American Academy of Ophthalmology. "Strabismus: Causes, Symptoms and Treatment." (2023)
  • Journal of American Association for Pediatric Ophthalmology and Strabismus. "Current management of childhood strabismus." (2022)
  • British Journal of Ophthalmology. "Advances in the understanding and treatment of strabismus." (2021)
  • American Optometric Association. "Care of the Patient with Strabismus: Reference Guide." (2023)