Strabismus is a condition of the eyes in which they are not properly aligned. Typical eyes pair together to see like the two lenses of binoculars. Other terms for strabismus are heterotropia, crossed eye, squint, cockeyed, wandering eye and wall eyed. Usually there is alack of coordination among the extra-ocular muscles. This stops the eyes from being able to gaze at the same point in space, interrupting typical ‘binocular’ vision. Strabismus can harm depth perception. Strabismus can however be a disorder of the brain, not just the muscles. The brain is unable to process signals to keep the eyes in the same direction or control the muscles.
Other names for this condition are divergence insufficiency, convergence excess, basic esotropia and basic exotropia. Strabismus is classified as either unilaterally or alternating. This classification is based on which eye is affected and is has two types unilateral strabismus and alternating strabismus. Unilateral strabismus is when only one eye is diverging. Alternating strabismus is when the eyes alternate ‘wandering’ behavior.
Strabismus is also classified on the time it develops. Congenital strabismus is when the strabismus is present at birth or shortly after birth. Acquired strabismus is develops later in life.
An eye exam will use what is called a cover test to diagnose a strabismus. The weak eye when isolated from the good eye (the good eye is covered) will focus on an image as long as the vision is okay. If the good eye is wandering, there will be no fixation change because it is already fixated. The direction of the deviation of the eye defines the type of tropia or phoria.
Another test for strabismus is called the Hirschberg test. It is used for children. In a dark room, the ophthalmologist or optometrist will shine a flashlight into a child’s eyes. The light reflects on the surface of the pupil. If the eye alignment is correct the reflection will be on the same spot on both eyes. If there is a strabismus, the reflection will be on different spots.
The goal for therapy is normal binocular vision at all distances and directions of eye gaze. Amblyopia is known as lazy eye and is not typically reduced by an eye patch of the dominant eye or corrective glasses or contact lenses. If it is minor it can be corrected with vision therapy (corrective glasses or a patch). An advanced strabismus is treated with a combination of therapies that can include corrective therapy, vision therapy or prism glasses depending on the reason for the alignment issues.
Surgery is aimed at changing the position or length (either making shorter or longer) of the extra-ocular muscles. It is frequently used as a cosmetic correction. Glasses change the individual’s focusing ability. Prisms change the method that light reaches the eyes and therefore, images in order to affect a change in eye position.
Early treatment of strabismus in infancy can decrease the possibility of developing focusing or depth perception problems. Eyes that stay misaligned may develop vision impairments. Prism lenses are not a cure for strabismus, but provide comfort and can stop double vision. Adults who develop strabismus usually have diplopia or double vision.
Strabismus in infancy or congenital strabismus can result in ambylopia in which the brain cannot interpret vision from the deviant eye and then begins to ignore visual input from the weak eye. Treatment and therapy is important in keeping the vision or developing the vision properly.
A pseudostrabismus is the appearance of a strabismus because of facial features. Infants and children with a nose bridge that is flat and wide appear to have a strabismus, but in fact do not. With age, the bridge will narrow and the folds in the eye corners will disappear. The flashlight test, known as the Hirschberg test, will determine if it is a true or pseudo strabismus.
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