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.
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.
Corticosteroids can be administered as pills, ointments, injections, or eye drops. The side effects they create in the eyes include:
Cataracts: Prolonged use of corticosteroids can lead to the development of cataracts in the eyes. Cataracts are treated with surgery.
Increased intraocular pressure: Corticosteroids may cause an increase in eye pressure.
Central serous retinopathy (CSR): Corticosteroids may cause fluid buildup in the macula of the eye, leading to vision loss. This vision loss can be permanent or partially or fully reversible.
• Combination pills: Contain estrogen and progesterone hormones. They are taken every day. • Progesterone-only pills: Taken every day. • Ormeloxifene (Centchroman): Estrogen receptor modulator. Taken once or twice a week.
Birth control pills can lead to dry eyes. Therefore, users of birth control pills may experience reduced tolerance to contact lenses.
When referring to the practices of the Uyghur Turks, acupuncture is known as a treatment method that originated from classical Chinese medicine and has a history of approximately 3500 years. The World Health Organization accepted acupuncture for certain diseases in 1979, while its official recognition in our country was established around 1991.
According to the philosophy of acupuncture, the body contains two opposing yet harmonious energies called Yin and Yang. The emblem depicting this concept is called Taiji (the Great Duality), where black symbolizes Yin and white symbolizes Yang.a
In classical Chinese medicine, the human body is considered a part of the living universe, and it’s believed that the universal force existing in everything also resides within humans. This energy, called “Chi,” circulates in channels called meridians throughout the human body. It’s believed that diseases occur when the flow of energy in these channels is disrupted. Acupuncture aims to restore balance by eliminating blockages in these channels and thus preventing or treating illnesses.
The human body has a high capacity for self-healing. Hippocrates mentioned the inherent healing power of living organisms and the “inner physician,” while Paracelsus stated, “No life can be maintained by the efforts of an external physician alone; the external physician can only assist the internal physician.”
Certain stimulation points in the body, known as acupuncture points, activate this power (bioregulatory power). There are approximately 2000 acupuncture points in the body. These points are interconnected, forming 12 pairs and 2 single meridians. About 70-80% of acupuncture points coincide with trigger points, and many also coincide with motor points of muscles.
When an acupuncture point is stimulated, local cellular stimuli originating from there reach the brain through neural communication, and from the brain, they are sent to the corresponding organs. Consequently, chemical substances, hormones, enzymes are secreted, and some cellular changes occur in the body. There is no need for external medication. It’s crucial to maintain this process at the appropriate level, neither exceeding nor falling short, to prevent hyperfunction or hypofunction because our organism is programmed to function normally.
Studies have investigated the use of acupuncture in inflammatory eye diseases, glaucoma, ocular hypertension, dry eye syndrome, paralytic strabismus, ocular allergic diseases, facial paralysis, blepharospasm, and optic atrophy. Cho, a Korean physicist, and his colleagues detected increased activity in the brain’s visual centers using single-photon emission computed tomography (SPECT) by stimulating acupuncture points around the eyes.
In a study investigating the efficacy of acupuncture in dry eye syndrome conducted by Nepp et al., 102 patients were divided into two groups according to traditional Chinese medicine (TCM): one group consisted mainly of patients with external factors (toxic, allergic, ocular surface inflammation and infection caused by medications, and contact lens use), and the second group consisted mainly of patients with internal factors (hormonal system disorders, immunological origin, psychogenic, and vitamin A deficiency). Acupuncture was administered to patients once a week for a total of 10 sessions, with each session lasting at least 30 minutes. Significant improvement in Schirmer test and BUT (break-up time) results and a significant decrease in the frequency of eye drop use were observed after treatment. Although no significant difference was observed between external and internal factors, more improvement in dry eye parameters was seen in the group where external factors predominated.
The least benefit from acupuncture was observed in patients with Sjogren’s syndrome. In another study conducted by Nepp et al., the efficacy of acupuncture was investigated in patients with ocular pain who did not respond to conventional treatment, including those with glaucoma, ocular migraine, dry eye, and blepharospasm. Significant improvements were observed in patients’ complaints. In another study by Gronlund et al. investigating the effectiveness of acupuncture in patients with dry eye syndrome, although significant improvement was observed in subjective findings in patients who received acupuncture compared to the control group, no difference was observed in dry eye parameters. The authors speculated that acupuncture improved corneal pain perception and accelerated corneal epithelial healing by stimulating the autonomic nerves, releasing various neurotransmitters such as substance P, calcitonin gene-related peptide (CGRP), norepinephrine, met-enkephalin, and increasing blood flow and secretion through the activation of secretory glands, particularly through potent vasodilators such as calcitonin gene-related peptide, neuropeptide Y, and vasoactive intestinal peptide (VIP).
