Strabismus, or strabismus in technical terms, is a misalignment of the eyes that look in different directions. The eyes can be either both looking inward or outward.
What is strabismus?
Strabismus is not only a “cosmetic blemish” for many sufferers, but there may be a visual impairment involved. In strabismus, because one of the two eyes is no longer parallel to the other, both are looking in a different direction. The deviation can occur in any direction, but horizontal deviations are the most common, resulting in either inward or outward strabismus. Since strabismus without treatment can lead to severe visual impairment of a healthy eye, it is especially important for children to receive timely treatment. Strabismus can be divided into three forms: latent strabismus, concomitant strabismus, and paralytic strabismus.
Causes
Strabismus can have various causes; this also depends on the form of strabismus. The cause of concomitant strabismus and latent strabismus is due to a disturbed equilibrium of the eye muscles. There are no exact reasons for concomitant strabismus, but genetic factors also play a role. Often one finds in the relatives of the affected person another person who squints or used to squint. Farsightedness or nearsightedness can be present at the same time. In latent strabismus, the eye is not able to merge the visual impressions very well, which occurs especially when the eyes are tired or strained for a long time. In paralytic strabismus, there is paralysis of the external eye muscles, which may be due to birth injuries, tumors, inflammation, or circulatory problems, for example.
Symptoms, complaints, and signs
Infants, because of their developmental stage, can suppress visual impression by squinting for a period of time. Suppression is considered a protective mechanism and prevents double vision. However, long-term suppression of the deviant eye provokes the development of amblyopia (amblyopia). This affects children with unilateral gaze displacement. The more dominant and frequently used eye is preferentially used by the brain. As a consequence, the visual performance of the inferior eye atrophies over a longer period of time. The decrease is sometimes so drastic that even large objects can only be recognized with difficulty. A similar course can be observed at a young age with the so-called paralytic defect. In general, strabismus does not only result in an aesthetic impairment, but also always leads to a visual impairment. First signs of strabismus are expressed in trembling eyes and a crooked head position. Sensitivity to light, frequent headaches and loss of concentration are also common. Burning eyes and constant blinking accompany a subsequent manifestation of reading difficulties. Latent strabismus only appears under certain influencing factors such as stress, overexertion or alcohol consumption. This hidden variant causes rapid fatigue and blurred visual impressions with a tendency to double contours or images. This description is especially true of strabismus acquired later in adulthood. Adult-onset paralysis results in sudden strabismus and abrupt visual impairment (double vision) combined with nausea and dizziness. Affected individuals often adopt a compensatory head posture to relieve pressure on the affected eye.
Diagnosis and course
Due to the visible eye misalignment, strabismus can already be diagnosed quickly. In order to accurately determine strabismus, various eye tests are performed, such as the uncover or cover test. In this test, one eye is covered and the doctor can then observe whether the other eye can readjust; in this case, it is a concomitant strabismus. The uncovering test determines whether the eye moves too slowly during the fusion and whether a latent strabismus is thus present. However, other visual disorders can also be detected with the tests described. The further course of strabismus depends, among other things, on early therapy. For example, concomitant strabismus in childhood can lead to permanent defective vision without treatment, which can then no longer be corrected from primary school age.Therefore, at best, strabismus should be detected at preschool age so that the prognosis for sharp and spatial vision is as good as possible.
Complications
Untreated strabismus in children can have serious consequences. Often, the unused eye develops a pronounced visual impairment that remains permanent without timely countermeasures. This is usually accompanied by headaches, which can develop into chronic migraines. If strabismus occurs later in life, significant visual problems can occur. Limited vision increases the risk of accidents and generally restricts the affected person considerably in everyday life and at work. Strabismus also has psychological consequences. The affected person often suffers from exclusion and as a result often develops an inferiority complex or depression. Surgical treatment of strabismus can result in loss or blindness. In addition, injuries to the eyeball as well as bruising and scarring are conceivable. Very rarely, vision worsens after surgery. In some circumstances, strabismus is over- or under-corrected and double vision persists or even increases. Even with assistive devices such as strabismus glasses, there is a risk of over- or under-correction. Shortly after the procedure, complications such as pain, bleeding or inflammation of the eye are possible.
When should you see a doctor?
Strabismus of one eye is not a disease in its own right, but a symptom of an underlying disease. In most cases, strabismus of one eye occurs at birth. One eye has more vision than the other, so strabismus can occur. An appropriate specialist should be consulted immediately and without delay to avoid complications later in life. Under certain circumstances, the visual acuity decreases, so that the strabismus can increase within a short period of time. However, with appropriate treatment, strabismus can be treated effectively and quickly. The course of the disease is completely different if the patient does not visit the doctor. In this case, the strabismus becomes more severe and vision may even be impaired. If a specialist is still not consulted, the worst case scenario can be loss of vision. If you want to avoid these and other complications at an early stage, you should see a doctor early.
Treatment and therapy
The form is also crucial in therapy for strabismus. The treatment of concomitant strabismus fixates on stereo vision, which means that the merging of visual impressions and spatial vision become more successful again. In addition, the eye misalignments are corrected to the normal position. Strabismus in children is always treated conservatively at the beginning. For example, with the help of glasses and a certain eye training, whereby the fusion or merging of individual visual impressions is to be improved again. What is also used to improve the misalignment of the eye is occlusion therapy, in which one eye is alternately covered with a patch. However, this taping must be done according to a specific schedule. The weaker eye is thus also forced to see, and children can thus relearn good vision. In adults, fusion training is achieved by sticking a matte film on a spectacle lens. Thus, double vision can be prevented. Those who suffer from severe strabismus may also consider eye muscle surgery. Often, this surgery is performed when binocular vision can no longer be achieved through conservative therapy. Paralytic strabismus is treated similarly, if it does not even regress on its own after several weeks.
Prevention
Strabismus cannot be prevented. It can only be prophylactically reduced in existing strabismus by starting early therapy. This refers especially to children, since strabismus occurs and is detected mainly in childhood. In cases of strabismus, consistent follow-up is advisable to avoid a possible recurrence of symptoms after successful treatment. This is especially important in children, as the condition of the eyes is still changing at their age. If strabismus nevertheless returns after therapy has been completed, further treatment options will be discussed during follow-up care. A second operation may be necessary.
Aftercare
Follow-up care after surgery for strabismus is useful to monitor the healing process. Therefore, the patient will see his or her ophthalmologist approximately one week after surgery. During the follow-up examination, the extent to which the eye has already swollen down and the current condition after surgery is as expected is checked. In addition, the ophthalmologist treats the usual complaints after surgery during the follow-up. With the help of drops or medication, the soreness of the operated eye is counteracted. The conjunctiva is swollen after strabismus surgery. Regular control is important to prevent or treat inflammation and irritation. In children with strabismus, the ophthalmologist will perform exercises to increase vision and thus permanently improve the condition of the eyes. This visual school is applied to children up to 15 years of age. After that, the visual acuity does not change.
You can do it yourself
In everyday life, the environmental influences should be adjusted to the natural needs of the human eye when reading, working at a screen or watching television. Lighting conditions should be checked and the distance of the person to a readable element should be optimized. Lighting conditions that are too bright or too dark place a greater strain on the human eye than is advisable. This can lead to problems or further impairment of vision. If the strabismus is not very pronounced, an improvement can be sought through targeted eye training on one’s own. Reading with only one eye is a common technique that can be used independently at any time. Alternately, texts or pictures should be fixed with the right eye and then with the left eye. Overall, it should always be ensured that both eyes are used equally, if possible. Overstraining only one eye should be avoided. Particularly in children, the eye malposition can be corrected by specifically influencing the visible area. A consciously aimed and self-initiated squinting of the eyes should be avoided in principle by people at any age. This process can exacerbate existing problems and have a negative impact on any therapy.
