Children and Strabismus

By: Anthony Tangeman

Strabismus, also known as crossed eyes or wandering eyes, is a vision condition caused by a muscular imbalance in the eyes. This imbalance prevents both eyes from aligning properly in order to focus on an object. One eye, and sometimes both eyes, will turn away in some direction from the object. In the case where one eye turns away (unilateral strabismus,) one eye becomes dominant over the other. There are different types and degrees of strabismus. We will be focusing on what unilateral strabismus is, how to look for it, and the treatment options for it.

As with any eye condition concerning babies and toddlers, early detection leads to the most successful treatment. Babies should have their first comprehensive eye exam at six months of age. It is then recommended for children to have exams again around the ages of three and six, and then once every year or two depending on your child’s vision.

While professional optometrists and ophthalmologists can easily spot and test for strabismus, it may be possible for you or other people to find signs and symptoms of strabismus in your child. One of the good things about strabismus compared to other vision conditions is that it is often very noticeable, and thus relatively easy to detect. Depending on the degree of strabismus, you might simply notice that your child’s eyes are not aligning properly. However, be aware that for very young children (from birth to three or four months) the eyes are still developing and misalignment might not necessarily mean that they have strabismus.

For babies older than four months, there are a couple signs you can look for. If your baby often tilts their head, it may mean that they are having trouble focusing on what they are trying to look at. Similarly, frequent squinting may also mean that they can not properly focus their eyes. Both signs could lead to a possible diagnosis of strabismus.

For children that can talk and communicate, a common complaint is that they will see double. This double-vision is caused by misaligned eyes. The brain ends up receiving two different images of the same object. Be aware that double-vision may disappear over time as the brain will learn to cope with the eyes. However, overall vision will be reduced and your child will still have strabismus.

Detection and treatment for strabismus is so important because if left unattended, your child can have lasting vision problems. Strabismus is one of the causes of amblyopia, which can be thought of as a more severe version of strabismus. Essentially, instead of there being a dominant and weak eye with strabismus, amblyopia has a dominant eye and a turned-off eye. Due to the muscular imbalance in strabismus, the weaker eye ends up having a weaker connection to the brain. Over time, this connection dwindles until the eye is eventually turned off. Amblyopia caused by strabismus is known as strabismic amblyopia.

It is important to note that strabismus is not synonymous with “lazy eye,” which is another word for amblyopia. Strabismus can be a cause of amblyopia, but not the other way around. The point where strabismus becomes amblyopia is when the brain completely disregards the weaker eye. It is important to make this distinction as potential treatment options change depending on whether your child has strabismus has strabismic amblyopia.

Amblyopia always needs to be addressed first and must precede any surgery that might occur. For more information on amblyopia and its treatment options, go here.

For strabismus, there are a couple of treatment options. The first is vision therapy, where the focus is on training and improving vision without the use of surgery. Through therapy, the eye muscles are strengthened, in turn fixing eye alignment. In addition, the connection between the eyes and brain increase, improving motor skills and the ability for the eyes to focus. Therapy is done through the use of optical devices, including lenses and prisms. Optometrists often will have patients come into their office for therapy, as well as having patients do additional therapy at home.

The second option is surgery. Surgery for strabismus is a procedure that connects the eye muscles and the eye itself. Depending on your child, they may need a weaker connection (recession) or a stronger connection (resection). In both cases, the eye muscles are stitched to the eye. The sutures can either be permanent or adjustable. In general, adjustable sutures are only advised for people at or beyond the age of young adult, or simply for people who are willing to cooperate with the procedure.

It is important to monitor your child following surgery as there are some effects to be aware of. Your child will likely have red, swollen eyes. The eyes might also be sore, in addition to giving off mucous. These conditions normally disappear over time. However, it is possible that double-vision can still exist post-surgery. If that happens, or if the redness and swelling persist or worsens, be sure to see the doctor as soon as possible.

In general, be sure to communicate with your child’s doctor in order to determine what to look out for, what your child can and cannot do immediately after surgery, and when to schedule follow-up appointments.

The key with strabismus, and other vision conditions, is to be proactive. Early detection and treatment give your child the best opportunity to grow and develop normally. Always be on the lookout for signs of vision problems, and be sure to schedule an eye exam if you think anything is wrong.

As always, feel free to contact the professionals at GoSmartEyewear for all of your vision related questions and concerns.