Strabismus in children and lazy eye

Strabismus is a condition where the eyes do not align in the same direction. Instead of looking straight ahead together, one eye may turn inward, outward, upward, or downward. This condition can be constant or intermittent. Strabismus is relatively common in children, and early diagnosis and treatment are important to prevent long term complications in visual development. Often, strabismus in children does not cause double vision because the brain suppresses the image from the misaligned eye.

Strabismus can be classified by the direction of the deviation: esotropia (inward turn), exotropia (outward turn), hypertropia (upward turn), and hypotropia (downward turn). It can be congenital or acquired. Possible causes include problems with the eye muscles that control eye movement, nerve issues affecting these muscles, or significant refractive errors such as high hyperopia (farsightedness). Sometimes, strabismus appears as part of a genetic syndrome or following a neurological condition. It is important to note that strabismus is not caused by watching television or using screens.

The most obvious sign of strabismus is a visible misalignment of the eyes. Other symptoms in children may include head tilting, closing one eye in bright sunlight, or complaints of double vision (though this is rare in young children). Diagnosis of strabismus is made through a comprehensive eye examination, which includes visual acuity testing, refraction (glasses prescription) measurement, and assessment of eye movements and alignment. These tests are adapted to the child's age and cooperation level, using various methods to evaluate eye alignment.

One of the most serious complications of childhood strabismus is the development of amblyopia, or lazy eye. When one eye consistently turns, the brain may ignore the blurry or double image coming from it, thereby suppressing visual development in that eye. If amblyopia is not treated early, vision in the affected eye may remain permanently poor, even if the strabismus is corrected later. Therefore, early diagnosis and treatment of strabismus are critical for preventing amblyopia and maintaining proper binocular vision.

Treatment for strabismus depends on its type, severity, and the child's age. Often, the first step is correcting refractive errors with glasses, especially in cases of accommodative strabismus caused by farsightedness. In cases of associated amblyopia, patching the stronger eye or using atropine drops in the good eye may be necessary to encourage the use of the amblyopic eye. Exercises can help selected children with convergence insufficiency, a difficulty coordinating the eyes for near work. They are not a proven treatment for most other forms of strabismus, including ordinary intermittent exotropia, and should be prescribed for a specific diagnosis.

When other treatments are insufficient, or in cases of significant strabismus, surgery may be considered to correct the misalignment. Strabismus surgery is a procedure aimed at changing the length or position of the external eye muscles, thereby realigning the eyes. The surgery is typically performed under general anesthesia. The goal of surgery is to improve eye alignment, restore proper binocular vision as much as possible, and enhance cosmetic appearance. Sometimes more than one surgery is needed to achieve the desired alignment.

After strabismus surgery, there may be redness, swelling, and mild discomfort in the eyes for several days. Generally, the child can return to normal activities within one to two weeks. It is important to understand that strabismus surgery does not cure amblyopia; therefore, if amblyopia is present, treatment for it must continue after surgery. In some cases, strabismus may recur or change over time, and additional treatments or repeat surgery may be necessary. Regular follow up with an ophthalmologist is essential after treatment.

Regular follow up with a pediatric ophthalmologist is crucial for any child with strabismus, even after treatment. The doctor will monitor visual development, eye alignment, and the need for treatment adjustments. You should contact your doctor if you notice a sudden change in eye alignment, if the child complains of new double vision, or if there are signs of severe pain or redness in the eye after surgery. Early detection and appropriate treatment are key to achieving the best possible outcomes for children with strabismus.