Medical & Surgical Ophthalmology

Pediatric ophthalmology

Strabismus

What is strabismus?

Strabismus is a disease typical of childhood in which the loss of ocular parallelism occurs in any position of the gaze, that is, the deviation of one eye in any position.

Deflection can be in, out, or vertical (up or down). It can be constant or intermittent, always in the same eye or alternate. It affects 2-4% of the child population, but adults can also present it.

Why does strabismus occur?

Hereditary factors and ophthalmological factors such as refractive errors intervene in the appearance of strabismus in childhood. Myopia (nearsighted), hyperopia (farsighted), astigmatism, eye diseases that cause poor vision in one eye, as well as diseases of the central nervous system.

In adults, it may be due to childhood strabismus that has been decompensated or to diseases that directly or indirectly affect the oculomotor system (diabetes, thyroid disease, trauma, brain tumours).

How does strabismus manifest?

The symptom is the ocular deviation that will alert the parents immediately. However, in the case of small ocular deviations, they can go unnoticed and are only detected in ophthalmological check-ups.

In adults, if it is not a childhood strabismus, double vision (diplopia) will appear.

In children, as a consequence of the deviation, the brain suppresses the image of the deviated eye, to avoid diplopia, which can cause amblyopia (lazy eye).

In the presence of an abnormal position of the head (torticollis) or a frequent winking of one eye, we should suspect a strabismus.

Treatments of strabismus

There are different types of strabismus and each one may require different treatments (optical correction, occlusions or surgery).

Before starting treatment, a complete ophthalmological examination should be carried out to assess the degree of ocular deviation and classify the type of strabismus.

In specific cases, botulinum toxin can be used as a treatment. Only a paediatric ophthalmologist or the strabologist can correctly diagnose strabismus and they are qualified to treat it.

Strabismus prevention

In a few cases it can be prevented, but it must be detected and treated early to avoid permanent sequelae such as lazy eye.

The child should be taken to ophthalmological check-ups from 2.5-3 years of age.

Summary

Debut

It can appear before 6 months of age, later or even in adulthood.

Symptoms

Ocular deviation is the main symptom of strabismus. There may be stiff neck or winking of one eye. In the adult it will give rise to double vision.

Prevention

Strabismus can be prevented in a few cases, but it must be detected and treated early to avoid permanent sequelae such as lazy eye. The child should be taken to ophthalmological check-ups from 2.5-3 years of age.

Treatment

There are different types of strabismus and each one may require different treatments (optical correction, occlusions, surgery or botulinum toxin). It is common that more than one surgery is necessary to correct the deviation. The patient will have to perform follow-up controls by the ophthalmologist.

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