Pediatric and Adult Strabismus

Strabismus (ocular misalignment):

Ocular misalignment prevents the brain from fusing images from each eye into a single image; this often affects depth perception and may result in double vision. In many cases, the brain will shut down or suppress visual input from the misaligned eye, causing potentially permanent vision loss (strabismic amblyopia).

Types of Strabismus:

  • Esotropia: This is when one eye turns inward (towards the nose), and is the most common type of childhood strabismus
  • Exotropia: This is when one eye turns outward (away from the nose).
  • Hypertropia: This is when one eye turns upward.
  • Hypotropia: This is when the deviated eye turns downward.
  • Pseduostrabismus: Refers to the false appearance of eye misalignment, usually secondary to prominent eyelid folds and /or a wide nasal bridge. Some children can have both wide lid folds / nasal bridge along with true ocular misalignment. Pseudostrabismus does not by itself eliminate the possibility of true eye crossing, according to ophthalmologist Benjamin Ticho.   Therefore, any child suspected of having ocular misalignment should have a thorough examination by a pediatric eye specialist.

Happy Smiling blue eyed baby

Strabismus treatment depends on the type and severity of ocular misalignment, and may include glasses, patching, eye exercises, and muscle surgery. In general, strabismus surgery is an outpatient procedure, considered when nonsurgical options are unsuccessful or not applicable.

Adult Strabismus:

Children with ocular misalignment (strabismus) usually do no complain of double vision (diplopia). When the strabismus begins later in life, on the other hand, diplopia is common, especially shortly after the onset of the misalignment. Typically, strabismic double vision is binocular (present when both eyes are open), and is not apparent when either eye is covered. Double vision which is present only in one eye (monocular diplopia) may be a sign of cataract, macular degeneration or other unilateral disease. Strabismus in adults can be treated with prism glasses, surgery or occlusion. Eye muscle surgery should not be cosmetic, but rather “reconstructive”; most insurances recognize this as a medical condition covered by standard policies. Although in the past, many adults were discouraged from seeking treatment for their strabismus, there is no age limitation for eye muscle surgery, and indeed these patients often have more postsurgical satisfaction than almost any condition.