It is crucial to detect strabismus immediately, as it may lead to other visual problems. It’s not always obvious if there is a problem.
Eye muscles of an infant are still developing during the first months of their life. It is normal for their eyes to wander. It is not a cause for concern unless your eyes are always misaligned.
Infants will have more control of their eye muscles by three months. A child’s eye doctor should evaluate the child if there is a suspicion of ocular misalignment.
Parents, teachers, school nurses, and pediatricians are usually the first to notice signs of childhood strabismus.
- The eye of the child can turn inward, outward, up or down.
- When looking at a particular object, the child will close one eye.
- When a child looks at something, they tilt their heads.
- Children squint, especially when in bright sunlight.
The child may also report to:
- Double vision
- Problems with depth perception
Eye turn can occur frequently or rarely. For example, eye fatigue or illness may be the trigger. In some cases the same eye is turned each time. In other cases, the eyes are alternated.
Strabismus causes
Six muscles work in concert to coordinate eye movements. Multiple nerves are controlled by the brain. Strabismus is caused by problems in the brain’s control center or with the eye muscles. Children with eye disorders and certain health conditions can also be affected.
Risk factors include:
- Family history. Strabismus occurs more often in children who have a parent with it or a sibling.
- Refractive Error. Children who are farsighted are more likely than others to develop strabismus because they must work harder to focus their vision.
- Eye Conditions. Strabismus is more common in people with certain eye conditions.
- Medical conditions. Strabismus occurs more often in children who have cerebral palsy or hydrocephalus.
Diagnosing strabismus
A pediatric ophthalmologist or optometrist can diagnose childhood strabismus. They may use tests such as:
- History (personal and family).
- Visual acuity measurement.
- Refractive error measurement.
- Eye alignment and focusing evaluation.
- Eye health assessment.
The strabismus will be classified by direction of the eye turn:
- Esotropia: inward turning.
- Exotropia: outward turning.
- Hypertropia: upward turning.
- Hypotropia: downward turning.
The strabismus is also assessed in terms of:
- How often do you turn your eyes (constantly or intermittently)?
- If they alternate or unilaterally (either one eye turns or the other).
The best treatment will depend on how you characterize the strabismus.
Strabismus treatments
When it comes to treating strabismus there are many treatment options, including glasses or contact lenses, prisms, vision therapy and surgery.
- Contact lenses or eyeglasses? In some cases, contact lenses or glasses are all you need to realign your eyes. The visual stimulus to align the eyes is restored by correcting refractive errors. It is more common in children who have hyperopia (farsightedness).
- Prism. This is a prism that changes the direction of the light entering the eyes. It can be a useful addition to glasses lenses.
- Blurring or patching on the eye that does not turn can encourage the eye that turns to straighten itself out. Over time, this can strengthen the eye that is misaligned. Children’s eye patch designs are available in a variety of colors and styles. Eye drops can be used to blur the pupils as an alternative.
- A vision therapy is a regimen of eye exercises that are designed to train your eyes and brain so they can work together better. The activities are designed to improve eye coordination and focusing. The treatment is guided by eye doctor visits and is supplemented with homework, similar to physical therapy.
- Surgery. Repositioning eye muscles can sometimes be done with surgery. Depending on the circumstances, this may be required in either one eye or both. To optimize the results of surgery, eyeglasses or patches, as well as vision therapy, are often used.
