There isn’t a single cause for the development of strabismus. Issues during pregnancy, whether the birth was problematic, the child’s development, and illnesses they’ve had can lead to strabismus. There is a genetic predisposition for strabismus. If there is someone in the family with a wandering eye, the chances of strabismus occurring in children increase.
In childhood, strabismus observed after the age of 2 is generally due to eye disorders. In a child predisposed to strabismus, eye misalignment may occur after a febrile illness or trauma (falls, surgeries, accidents).
The center that controls the movement of our eye muscles is in the brain, so paralysis of the nerves can also cause eye misalignment. Accidents, head trauma, febrile illnesses, and conditions such as hypertension and diabetes in advanced age can lead to nerve paralysis in the eye. Treatment for strabismus resulting from this kind of paralysis can vary depending on whether the paralysis is permanent or not. Lazy eye in children, which can cause double vision in older age groups, requires treatment.
Types of Strabismus
Strabismus is classified based on the direction in which the eyes deviate.
Inward strabismus (Esotropia)
Outward strabismus (Exotropia)
Upward strabismus (Hypertropia)
Downward strabismus (Hypotropia)
There are also special types of strabismus that fall outside of this classification.
Strabismus in Adulthood
Strabismus that occurs in adulthood can result from various reasons affecting the nerves that control eye movements (trauma, diabetes, cardiovascular diseases, hypertension, various infections, tumors, or poisonings). Treatment should first address the causes leading to strabismus. Surgery may be required after a certain period, especially when there are complaints of double vision. In the treatment of strabismus, besides using glasses, orthoptic exercises with special devices, patching therapy, medical treatment with various drops, and surgical treatment can be applied.
Hidden Strabismus
Hidden strabismus is misalignment that becomes apparent when one eye is covered. Hidden misalignment is a common eye condition in our country. While both eyes are open, the brain ensures that the eyes remain parallel with a mechanism. However, when one eye is covered, this mechanism is disrupted, and misalignment occurs in the covered eye.
In such cases, the patient is often unaware of the misalignment and may present complaints such as fatigue, redness, pain, dryness, and headache in the eyes. If the patient also has a refractive error, these complaints may occur earlier. The patient especially complains of headaches after reading at close range. Hidden strabismus can be treated with appropriate glasses and orthoptic (with special devices) exercises.
How is Strabismus Treated?
Since strabismus can stem from many causes, treatment varies from person to person.
Glasses: Some types of strabismus occur due to refractive errors. When the patient starts wearing glasses, the strabismus corrects. Glasses are sufficient for such types of strabismus.
Patching Therapy: This treatment method can be applied if the patient has lazy eye.
Orthoptic Treatment: This treatment is applied to improve binocular vision and depth perception with both eyes. These two functions not only ensure that the eyes remain parallel but are also essential in our daily lives. It helps us to be more comfortable and successful when driving, playing sports that require distance and time adjustment such as basketball, tennis.
Surgical Intervention: Congenital misalignments generally need to be operated on in the early period (6 months – 1 year) and usually do not require glasses. Most misalignments occur around the age of 2–3 and can usually be completely corrected with glasses. Misalignments that do not improve with glasses may require surgical treatment. Strabismus surgeries are generally performed under general anesthesia. The basic principle of surgeries is to reduce or increase the strength of the muscles attached to the eyeball or change their positions. Early diagnosis and treatment of strabismus can prevent lazy eye and provide 3D vision. Therefore, any child suspected of having strabismus should be taken to a strabismus specialist eye doctor without waiting for a certain age.
Botox: In some types of strabismus, botulinum toxin (BOTOX) can also be used in treatment. BOTOX can be effective in cases where there is strabismus due to paralysis, cases where surgery has not fully corrected the condition, and cases of strabismus due to thyroid disease. Sudden misalignment due to paralysis often comes with double vision, which is quite challenging for the patient. The general approach in such cases is to wait for 6–8 months, but botox application can be performed during this waiting period to reduce double vision. Full recovery is possible with prompt diagnosis and treatment immediately after the onset of strabismus.
NSAIDs can create sensitivity to light in the eyes. When exposed to sunlight, drugs from this group can cause a reaction in the eyes. Specifically, drugs from this group, especially 2-arylpropionic acid, are associated with light sensitivity, but other drugs (such as piroxicam, diclofenac, and benzydamine) may also cause light sensitivity.
Narcotic painkillers like morphine can cause constriction of the pupil.
