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Strabismus

A visual condition in which the optical axes cannot direct to the same object, due to the improper contraction or relaxation of one or more muscles of the eyeball.

What does it consist of Strabismus ?

Strabismus, also known as “lazy eye,” is an eye condition in which both eyes do not look in the same direction simultaneously . This can lead to double vision, visual fatigue, a loss of 3D vision (stereopsis), and, in some cases, amblyopia (lazy eye).

According to the direction in which the eye deviates, strabismus can be classified as:

Esotropia or convergent strabismus: deviation of the eyes inward.
Exotropia or divergent strabismus: deviation of the eyes outward.
Hypertropia: deviation of the eyes upward.
Hypotropia: deviation of the eyes downward.

The consequences and treatment vary mainly depending on whether it occurs during childhood or adulthood.

Childhood Strabismus

Childhood strabismus can be caused by a congenital alteration in the development of the extraocular muscles (the muscles that allow the movement of the eyeballs) or by eye diseases that reduce the vision in one eye (such as congenital cataracts, diseases affecting the retina or optic nerve, etc.). However, the most common causes are refractive errors (myopia, astigmatism, and especially hyperopia).

The main concern with strabismus occurring during childhood is the risk of amblyopia, commonly known as “lazy eye.” Amblyopia arises because one eye does not receive a clear enough image, and therefore, the visual pathways do not develop properly, preventing that eye from achieving maximum vision. While this can vary from person to person, we have until approximately 8 years of age to stimulate the vision of the strabismic eye and avoid amblyopia.

Another important consequence of childhood strabismus is the deficient development of stereopsis, or 3D vision.

Patients may complain of visual fatigue, difficulty reading or performing near-vision activities, or torticollis to avoid positioning the eyes where the deviation is most pronounced.

To treat childhood strabismus, we can use:

Glasses: important when the etiology is a refractive error to ensure the image reaches the retina clearly.
Penalization of the healthy eye: to force the deviated eye to work and avoid amblyopia. This can be done in various ways, but the most common is through occlusions.
Visual therapy: aimed at stimulating the vision of the deviated eye or encouraging certain eye movements.
Surgery: Depending on the causes of strabismus, surgery can weaken some muscles (muscle recessions) or strengthen muscle action (muscle resections).

More information about Strabismus

Strabismus in Adults

Strabismus in adulthood may result from the decompensation of mild childhood strabismus that has been compensated for years until it becomes decompensated for some reason. However, several causes need to be ruled out in an adult with strabismus, such as thyroid eye disease, myasthenia gravis, or paresis or paralysis of the cranial nerves.

Significant vision loss in one eye can also lead to its deviation, which is known as sensory strabismus.

In adults, the main symptom is binocular diplopia or double vision, as the same image does not reach the brain from both eyes. An exception is that diplopia does not occur in sensory strabismus, where one eye must have significant vision loss.

It can also lead to visual fatigue, especially for near vision, loss of stereopsis (which complicates estimating the distance of objects or their approach speed), or image confusion (seeing two different overlapping images).

Torticollis to avoid double vision is common in adult strabismus.

The treatment primarily aims to prevent diplopia, as it can be a very disabling symptom in some cases. Therefore, we can use:

Visual Therapy: Useful for mild divergent strabismus that causes fatigue in near vision. This involves convergence exercises to stimulate this movement.
Prism Glasses: These do not change the position of the eye but instead deviate the light so that both eyes send the same image to the brain. They are very useful for mild or moderate deviations.
Neuromodulator Injections: These decrease the contraction of certain muscles and help prevent the fibrosis of muscles that oppose the muscle that is not functioning correctly.
Surgery: The main goal is to avoid diplopia in the primary position (looking straight ahead).

Treatments related to Strabismus

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Specialists in the pathology Strabismus

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