There is not a single cause for the development of strabismus. A problematic pregnancy period, whether the birth was problematic, the child’s development, and illnesses they have had can lead to strabismus. There is a genetic predisposition for strabismus. If there is a family history of eye misalignment, the chances of strabismus occurring in children increase.
In childhood, strabismus occurring after the age of 2 is generally due to eye disorders. In a child predisposed to strabismus, eye misalignment may begin after a feverish illness or a trauma (fall, surgeries, accidents).
The center in the brain that controls the movement of our eye muscles, so paralysis occurring in the nerves can also cause eye misalignment. Accidents, head trauma, febrile illnesses, and conditions such as hypertension and diabetes at an advanced age can cause paralysis in the nerves of the eye. Treatment for strabismus resulting from such conditions can vary depending on whether the paralysis is permanent. Amblyopia in children must be treated because it can cause double vision in older age groups.
Types of Strabismus
Strabismus is named according to the directions 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 do not fit into this classification;
Causes of Strabismus…
There is not a single cause for the development of strabismus. A problematic pregnancy period, whether the birth was problematic, the child’s development, and illnesses they have had can lead to strabismus. There is a genetic predisposition for strabismus. If there is a family history of eye misalignment, the chances of strabismus occurring in children increase.
In childhood, strabismus occurring after the age of 2 is generally due to eye disorders. In a child predisposed to strabismus, eye misalignment may begin after a feverish illness or a trauma (fall, surgeries, accidents).
The center in the brain that controls the movement of our eye muscles, so paralysis occurring in the nerves can also cause eye misalignment. Accidents, head trauma, febrile illnesses, and conditions such as hypertension and diabetes at an advanced age can cause paralysis in the nerves of the eye. Treatment for strabismus resulting from such conditions can vary depending on whether the paralysis is permanent. Amblyopia in children must be treated because it can cause double vision in older age groups.
Types of Strabismus
Strabismus is named according to the directions 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 do not fit into this classification;
Strabismus Seen in Adults
Strabismus occurring in adulthood can be due to various reasons affecting the nerves that control eye movements (trauma, diabetes, cardiovascular diseases, hypertension, various infections, tumors, or poisonings). Treatment should first focus on the underlying causes of strabismus. Surgery may be necessary after a certain period, especially in cases where there is also complaints of double vision. In the treatment of strabismus, besides the use of glasses, orthoptic therapy using 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 deviation is a common eye condition in our country. While both eyes are open, the brain ensures that the eyes remain parallel with a connecting mechanism. However, when one eye is covered, this mechanism is disrupted, and misalignment occurs in the covered eye.
In such cases, the patient is usually unaware of the deviation and seeks medical help due to complaints such as eye fatigue, redness, pain, dryness, and headaches. If the patient also has a vision problem, these complaints may arise earlier. Especially after close reading, the patient complains of headaches. Hidden strabismus can be treated with appropriate glasses and orthoptic (with special devices) exercises.
How Is Strabismus Treated?
Since strabismus can originate from many causes, the treatment varies from person to person.
Glasses: Some types of strabismus occur due to refractive errors. When the patient starts wearing glasses, the strabismus improves. Glasses are sufficient for such types of strabismus. Patching Therapy: This treatment method can be applied if there is amblyopia in the patient’s eye. Orthoptic Therapy: This treatment is applied to improve the vision and depth perception with both eyes. These two functions not only ensure that the eyes remain parallel but are also crucial 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 and tennis. Surgical Intervention: Congenital deviations usually require surgery, which typically does not require glasses and should be performed at an early age (6 months to 1 year). Most deviations occur around the age of 2–3 and can usually be corrected with glasses. Surgical treatment is required for deviations that do not improve even with glasses. Strabismus surgeries are usually performed under general anesthesia. The basic principle of surgery is to reduce or increase the force of the muscles attached to the eyeball or to change their positions. Early diagnosis and treatment can prevent amblyopia and provide three-dimensional vision. Therefore, any child with suspected strabismus should be taken to an ophthalmologist specializing in strabismus without waiting for a certain age. Botox: In some cases of strabismus, botulinum toxin (BOTOX) can also be used in treatment. BOTOX can be effective in deviations caused by paralysis, in cases where complete recovery has not been achieved after surgery, and in cases of eye misalignment due to thyroid disease. Deviations that occur suddenly due to paralysis generally cause double vision and are quite difficult for the patient. The general tendency in such deviations is to wait for 6–8 months, but BOTOX application can be performed during the waiting period to reduce double vision. Immediate treatment after the onset of strabismus can lead to complete recovery.
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.
After one week. At that time, you can wash your hair by tilting your head back like hairdressers do.
How long will the lens implanted in my eye after surgery stay?
For a lifetime.
Is the brand and quality of the lens used very important?
It is important to use intraocular lenses that have the European CE mark and American FDA approval. The quality of vision is affected by the lens material and design. The loss of transparency in the lens capsule is also related to lens design.
Will cataracts recur in the eye after surgery?
What is secondary cataract?
An artificial lens is placed inside the eye’s own capsule. Sometimes, this capsule loses its transparency, which is called secondary cataract. Laser treatment of the center of this capsule may be necessary 6 months after surgery.
Will I have stitches or stitchless surgery?
Cataract surgery is now performed stitchlessly using a technique called phacoemulsification.
Will I have surgery with laser technology?
Current cataract surgery is performed using phacoemulsification technique with the use of ultrasound, not laser as commonly believed.
Should I continue taking my medications for other conditions in the days leading up to the surgery?
You should continue taking your other medications. Only stop the following medications before surgery:
Aspirin: Stop 10 days before.
Coumadin: Stop 7 days before.
Flomax: Stop 2 weeks before.
I have eye drops like my blood pressure medication for the eye to be operated on. Should I continue using them?
Yes, continue with all your drops. Only if you are using the following drops, stop them 2 weeks before surgery:
Pilocarpine
Isoptocarpine
Pilogel
Carbachol
Should I come to the surgery on an empty stomach?
No. Since the operation will be performed with numbing eye drops, it is not necessary to be fasting.
Will I see the surgery?
No. You will only see shadows and colors.
Will I need to wear glasses?
A glasses examination will be done after one month. You may need a thin pair of glasses to see distance clearly, or you may not. However, in an eye with a standard intraocular lens, near glasses are always required to see up close. In an eye with a lens that enables both distance and near vision, 70% of patients can see both near and far without glasses.
Transmission Routes The virus enters the body through mucous membranes and skin. Therefore, close personal contact is required for transmission. We typically contract the virus from cold sores and secretions on the lips during childhood. By the age of five, 60% of the population is infected with Herpes. It is reported that 20-45% of the world population has had cold sores on the lips. The disease is not transmitted through the air or swimming pools. When the disease is first acquired, only 1-6% of cases show symptoms. In other words, if you come into contact with someone who has a cold sore, the virus can be transmitted to you. You have a 1-6% chance of developing a sore within 3-9 days, and a 94-99% chance of not developing one. However, the virus remains in your body. The site of settlement is the part of the sensory nerve in the face called the “ganglion.” Subsequently, when your immunity weakens, the virus can move to your lips or eyes and cause the disease.
Frequency of Recurrence 10% of individuals experience eye herpes recurrence within one year, and 23% within two years. The more attacks you have had, the higher the chance of recurrence in the future. The frequency of attacks is not related to gender or the age at which the first outbreak occurred. Recurrences occur more often between November and February. The frequency of eye herpes in the community is 149 per 100,000.
Causes of Recurrence of Eye Herpes The virus is mainly located in the nerve ganglion. However, it can also settle in the cornea. Stress, fatigue, and sorrow can lead to the recurrence of eye herpes. Sunlight, trauma, surgery, temperature changes, febrile illnesses, menstruation, other infections, emotional stress, and some glaucoma medications (Prostaglandin F2 analogues) can also activate the herpes virus. Having eye herpes in both eyes indicates a problem with the immune system.
Symptoms of Eye Herpes
Redness and blisters on the eyelids (herpetic blepharitis)
Conjunctivitis: Follicular conjunctivitis manifests itself with redness and discharge in the eyes.
Cornea (the transparent outer layer of the eye): It causes various forms of disease such as infectious epithelial keratitis, neurotrophic keratopathy, stromal keratitis, and endotheliitis. It affects one eye and only affects both eyes in 3% of cases. 40% of individuals with both eyes affected are atopic (allergic). When the cornea is affected, there is pain, light sensitivity, tearing, and varying degrees of vision loss.
Uvea: Iridocyclitis manifests itself with redness, pain, and blurred vision.
Diagnosis Standard eye examination is sufficient to make a diagnosis. Samples are taken from the eye for other diagnostic methods: The sample is stained by pathologists. Cell culture, immunological tests, PCR, and electron microscopy examinations can be performed.
Treatment Depending on the type of disease, antiviral drops-ointments, corticosteroid drops, and antiviral pills are used in treatment. Eye herpes in the cornea can resolve without leaving any marks, but it can also affect the cornea more deeply and permanently reduce vision. In some cases, the cornea can be perforated due to the sore. In such cases, the cornea is repaired with a procedure called tissue adhesive application. When permanent marks remain on the cornea, corneal transplantation is required to improve vision. The success rate of corneal transplantation for eye herpes is around 50-80%. The main factors limiting the success of corneal transplantation are vascularization of the cornea and the virus affecting the transplanted new cornea.
Dry eye syndrome occurs either due to insufficient production of tears or excessive evaporation of existing tears.
Insufficient Tear Production Insufficient tear production can result from a condition called Sjogren’s syndrome, which is a rheumatic disease. In addition to causing dry eyes, Sjogren’s syndrome also leads to dry mouth. In this condition, the tear glands are damaged due to an inflammatory reaction of unknown cause. Sjogren’s syndrome may coexist with other rheumatic diseases.
When reduced tear secretion is not due to Sjogren’s syndrome, it may occur due to the following conditions:
Aging
Diseases that damage the tear glands (e.g., the type of thyroid disease that affects the eyes)
Blockage of the tear ducts (e.g., eye diseases like trachoma)
Certain neurological diseases (e.g., Riley-Day syndrome)
Excessive Evaporation of Existing Tears Excessive evaporation can result from factors such as contact lens wear and computer use. Problems with the secretion of oil from the glands at the base of the eyelashes can also lead to insufficient oil in the tear film, resulting in excessive evaporation.
Symptoms of Dry Eye Syndrome
Itching
Sensation of foreign body in the eye
Burning sensation
Sticky discharge
Blurred vision
Redness
Light sensitivity
Feeling of fatigue
Diagnosis
Tear Break-Up Time: Normally, tears should remain on the surface of the eye for at least 10 seconds after each blink. The formation of dry areas on the surface before 10 seconds (i.e., tear break-up) is abnormal and indicates insufficient tear production.
Schirmer Test: After numbing the eyes with eye drops, strips of paper marked in millimeters are placed under the lower eyelids. After five minutes, there should be at least 10 mm of wetness on the paper strip. Wetness of less than 5 mm on the paper indicates dry eye syndrome.
Evaluation of the eye surface with various dyes: Fluorescein or rose bengal dyes are applied to the eye surface. These dyes stain dry areas on the surface and shed cells due to dryness. The presence and amount of staining indicate the presence and severity of dry eye.
Treatment
General measures: Humidifying indoor environments, placing water-filled containers on radiators, using cold vapor machines, etc.
Artificial tear drops: These drops moisturize the eyes. Those that do not contain preservatives have no toxic effects.
Tear-enhancing drops: These drops stimulate increased tear production.
Punctal plugs: Tears flow from the eyes toward the nose through small openings called puncta located on the inner sides of the upper and lower eyelids. In individuals with dry eyes, plugs can be inserted into the puncta to prevent the existing tears from draining into the nose. This helps the tears remain on the eye surface.
Simple Bacterial Conjunctivitis Simple bacterial conjunctivitis is the most common form of conjunctivitis encountered in daily life. The symptoms of simple bacterial conjunctivitis include:
Redness in the eyes
Itching
Burning sensation
Discharge
Eyelids sticking together in the morning due to discharge
Treatment for simple bacterial conjunctivitis involves using antibiotic eye drops during the day and antibiotic ointment before bedtime. Bacterial conjunctivitis typically heals within 10-14 days.
Viral Conjunctivitis The most common cause of viral conjunctivitis is a virus called adenovirus. Secretions from the respiratory tract or eyes of individuals carrying this virus can cause transmission. Infection symptoms begin 4-10 days after exposure to the virus. For the following 12 days, the infected individual becomes contagious.
Symptoms of adenoviral conjunctivitis include:
Redness and bloodshot eyes
Watery eyes
Itching
Light sensitivity
Swelling of the eyelids
Swollen lymph nodes in front of the ears
In 80% of viral conjunctivitis cases, the cornea (transparent layer of the eye) is also affected. About 7-10 days after the onset of symptoms, white spots appear on the cornea. These spots may fade within two weeks, but if they penetrate deeper, fading may take months to years.
Treatment for adenoviral conjunctivitis involves the use of corticosteroid eye drops if there is excessive itching in the eyes or if the white spots on the cornea penetrate deeply.
