Strabismus or crossed eyes is an abnormality of the position of the eyes in which the eyes cannot be focused on the same fixation point. It usually occurs in childhood, but strabismus can also occur in adults. Strabismus is estimated to affect 3 to 5% of the Dutch population. There is no clear difference between boys and girls. If strabismus is suspected, referral to an orthoptist is always recommended. Orthoptics is the doctrine of seeing ‘right’ or ‘right’.
- What is strabismus?
- Strabismus
- Forms of strabismus
- What are the symptoms of strabismus?
- Symptoms
- Difficult to recognize
- Lazy eye
- Pseudostrabism
- What causes strabismus?
- How is strabismus treated?
- Orthopist
- Strabismus: surgery
- Treating lazy eye
- Controls
What is strabismus?
Strabismus
The medical name for strabismus is ‘strabismus’. Strabismus is a condition in which a child cannot focus both eyes on one fixation point. The strabismus eye can be directed inward, outward, upward or downward. A combination of these is also possible. Strabismus can lead to the development of a lazy eye (amblyopia) in children aged 16 to 18 weeks. It is estimated that strabismus occurs in 2-5 percent of children. The condition can also occur in adults.
Forms of strabismus
Strabismus can occur in different ways:
- Inward direction (esotropia);
- Outward direction (exotropia);
- Upwards (hypertropia); or
- Down (hypotropia).
What are the symptoms of strabismus?
Symptoms
Shortly after birth, many babies have a varying slightly divergent eye position, with one eye turned outward. This will often recover in the first three months of life. However, a persistent strong deviation in the eye position in the first months may indicate an underlying condition. After the age of three months, all strabismus is pathological.
Difficult to recognize
Strabismus is often difficult to recognize by parents. In some children, strabismus is sometimes present and sometimes not. There are children who only look cross-eyed when they are tired. A child can squint in all directions: the crossed eye can look outward, inward, up, down or in between.
Lazy eye
Strabismus causes a lazy eye. A child who looks cross-eyed sees double and that is extremely difficult. The child’s brain corrects this problem by suppressing the image coming from the crossed eye. In that case, the child only looks with one eye and no longer sees double. The disabled eye is called a ‘lazy eye’ because it no longer learns to see, causing visual acuity to gradually decrease.
Pseudostrabism
There may also be pseudostrabismus, which is an apparent strabismus. This gives the impression that there is strabismus, for example as a result of a wide bridge of the nose.
What causes strabismus?
Strabismus can have various causes; both hereditary and environmental factors can play a role. Environmental factors include ophthalmological abnormalities (if one or more of the six eye muscles that hold the eye in the eye socket are too long or too short, the eye can become crooked and cross-eyed), cranial nerve disorders (the eye muscles are controlled by cranial nerves). , premature birth, smoking during pregnancy, etc. A child can also have strabismus due to a difference in strength between the two eyes, as a result of which he or she is unable to focus the eyes properly.
How is strabismus treated?
Orthopist
Every child’s eyes are checked several times during visits to the clinic in the first years of life. This is done on the basis of a fixed research programme. Early detection and treatment are essential for preventing lazy eye. A child with crossed eyes is referred to an orthoptist. This is a paramedic who deals with a specific part of ophthalmology, such as strabismus.
Strabismus: surgery
In a large proportion of strabismus children, the eye position is improved by means of an operation, in medical terms called a ‘strabismus operation’. During strabismus surgery, a number of eye muscles that move the eye and are attached to the outside of the eyeball are weakened or strengthened by moving or shortening them. In many cases, surgery is performed on both eyes and usually on multiple muscles per eye. The aim is to get the crooked eye position as straight as possible, so that the eyes work better together. The operation takes approximately 45 minutes and takes place under general anesthesia. The final result can only be assessed several months after the operation.
Treating lazy eye
Before proceeding with an eye position correction, it is necessary that the lazy eye is treated first. This may take some time. There are roughly three possible treatments for lazy eye:
- Masking the good eye, which stimulates the lazy eye;
- Drip from the good eye, so that the lazy eye is stimulated to look;
- Prescribing glasses in combination with masking or dripping the good eye.
Controls
The orthoptist will monitor the progress of the treatment through checks and determine further policy depending on the progress.
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