Strabismus, often referred to as “crossed eyes” or “squint,” is a vision disorder characterized by the misalignment of the eyes. It manifests as a condition where either one or both eyes can display a consistent or sporadic misalignment, causing one eye to gaze straight ahead and the other to deviate inwards, outwards, upwards, or downwards.

How is Strabismus caused?

Under normal circumstances, both eyes focus on the same object, allowing the brain to merge the two separate images from each eye into a unified image. This harmonious coordination relies on a complex system that transmits commands from the brain to the various extraocular muscles. When this intricate system malfunctions, it results in the condition known as Strabismus.

Strabismus manifests in different forms, depending on the direction of the eye misalignment, which can be horizontal, vertical, torsional, or a combination thereof. This misalignment may impact a single eye exclusively or alternate between eyes, meaning that either eye can deviate at different times. The degree of deviation can vary, and it may be persistent or sporadic, occurring primarily when an individual is tired, ill, or distracted.

Additionally, Strabismus can develop at any stage of life, classifying as congenital if it emerges before six months of age, acquired in childhood if it initiates between ages two and three, or adult-onset Strabismus if it arises in adulthood.

What are the Symptoms of Strabismus?

Strabismus can manifest with various symptoms depending on the type and severity of the condition. Common symptoms of Strabismus include:

Misaligned Eyes: The primary symptom of Strabismus is the misalignment of one or both eyes. One eye may turn inward (esotropia), outward (exotropia), upward (hypertropia), or downward (hypotropia), while the other eye remains focused on an object.
Double Vision: When the eyes are misaligned, they may send conflicting visual signals to the brain, resulting in double vision (diplopia). Double vision can be constant or intermittent, depending on the type of Strabismus.
Eye Fatigue: Strabismus can lead to eye strain, fatigue, and discomfort, particularly in the misaligned eye. This can result in headaches, eye pain, or aching around the eyes.
Difficulty with Depth Perception: Misaligned eyes can disrupt the brain’s ability to create a single, three-dimensional image from the input of both eyes. As a result, individuals with Strabismus may have difficulty judging depth and spatial relationships.
Amblyopia (Lazy Eye): Sometimes, the brain may suppress or ignore the image from the misaligned eye to avoid double vision. This can lead to amblyopia, commonly called a “lazy eye.” Amblyopia can result in reduced vision in the affected eye if not treated promptly during childhood.
Abnormal Head Posture (Torticollis): Some individuals with Strabismus may adopt an unusual head posture to compensate for the misalignment of their eyes. This is known as torticollis and is an attempt to position the eyes to minimize double vision.
Reduced Visual Acuity: In cases of untreated Strabismus, the visual acuity of the misaligned eye may decrease over time. This can lead to decreased visual function in the affected eye.
Difficulty with Activities Requiring Focused Vision: People with Strabismus may have difficulty with tasks that require precise visual coordination, such as reading, writing, drawing, and sports.

What are the Causes of Strabismus?

The exact cause of Strabismus may differ from one individual to another. Here are some of the common factors and causes associated with Strabismus:

Muscular Imbalance: One of the primary causes of Strabismus is an imbalance in the muscles that control eye movement. If the muscles that move the eyes are not working together correctly or one muscle is weaker or stronger than its counterpart, it can lead to misalignment.
Neurological Factors: Problems with the brain or the nerves that control eye movement can also contribute to Strabismus. Conditions that affect the brain, such as strokes, tumors, or neurological disorders, may disrupt the signals that coordinate eye movement.
Genetic Factors: Evidence suggests that a genetic predisposition can play a role in developing Strabismus. The risk of developing the condition may be higher if there is a family history of Strabismus.
Refractive Errors: Uncorrected refractive errors like nearsightedness (myopia), farsightedness (hyperopia), or astigmatism can lead to eye strain and may contribute to Strabismus, especially when left uncorrected.
Childhood Factors: Strabismus can develop in childhood due to various factors, including premature birth, low birth weight, and developmental issues. It can also be associated with other eye conditions, such as congenital cataracts or retinopathy of prematurity.
Medical Conditions: Certain medical conditions, such as Down syndrome and cerebral palsy, are associated with a higher risk of Strabismus.
Eye Injuries or Trauma: Trauma to the eye or head injuries can damage the eye muscles or the nerves controlling eye movement, leading to Strabismus.
Systemic Illnesses: Some systemic illnesses, like thyroid disorders, can affect eye muscle function and contribute to Strabismus.

What are the types of Strabismus?

Several types of Strabismus are classified based on the direction of eye misalignment, the main types include:

Esotropia: In esotropia, one eye turns inward towards the nose while the other remains straight or focuses on the target. This is called “cross-eyed” Strabismus.
Exotropia: Exotropia is the opposite of esotropia. In this type, one eye turns outward away from the nose while the other eye maintains its alignment. Exotropia is often referred to as “wall-eyed” Strabismus.
Hypertropia: In hypertropia, one eye is positioned higher than the other when looking at an object. This type of Strabismus involves vertical misalignment.
Hypotropia: Hypotropia is the opposite of hypertropia. In this type, one eye is positioned lower than the other eye when focusing on an object, also involving vertical misalignment.
Alternating Strabismus: In alternating Strabismus, either eye may deviate, meaning that the misalignment switches between the two eyes at different times. This type can be esotropia or exotropia.
Intermittent Strabismus: Intermittent Strabismus occurs sporadically, with the eye(s) alternating between proper alignment and misalignment. It may be more noticeable when a person is tired or stressed.
Concomitant Strabismus: Concomitant Strabismus is characterized by a consistent angle of deviation, regardless of the direction the eyes are looking. The misalignment is similar in all gaze positions.
Accommodative Esotropia: This type of Strabismus is often associated with hyperopia (farsightedness). The eyes may turn inward when trying to focus on close-up objects, such as during reading or other near tasks.
Non-Accommodative Esotropia: Non-accommodative esotropia occurs without needing accommodation (focusing). It often appears early in life and may be unrelated to refractive errors.
Duane Syndrome: A rare type of Strabismus characterized by limited horizontal eye movement. It is typically congenital and involves retraction of the eyeball when the eye tries to move outward.

How is Strabismus Diagnosed?

Diagnosing Strabismus at Novomed involves a comprehensive and patient-centered approach, combining state-of-the-art diagnostic techniques with the expertise of highly trained eye care specialists.

The diagnosis of Strabismus typically includes the following steps:

Initial Assessment and Patient History: The diagnostic process begins with thoroughly reviewing the patient’s medical history. This includes discussing any symptoms of eye misalignment, family history of Strabismus, and other relevant medical conditions or treatments.
Visual Acuity Testing: Visual Acuity test helps determine the clarity of vision in each eye and identifies any underlying refractive errors, such as nearsightedness, farsightedness, or astigmatism.
Cover-Uncover Test: The cover-uncover test is a fundamental part of diagnosing Strabismus. During this test, the patient is asked to focus on a specific target while one eye is covered and then uncovered. The eye care specialist observes the movement of the eyes to detect any misalignment. This test helps in assessing the type and degree of Strabismus.
Ocular Motility Examination: Experts thoroughly examine the patient’s eye movements. This includes evaluating how well the eyes move in different directions and whether eye mobility has any limitations or restrictions.
Prism Cover Test: Sometimes, a prism cover test may be performed to quantify the degree of eye misalignment. Special prisms are used to measure the deviation angle and help accurately determine the extent of Strabismus.
Refraction: Refraction testing is performed to determine if refractive errors contribute to the Strabismus. If needed, eyeglass prescriptions can be provided to correct any refractive issues.
Dilation of the Pupils: In certain situations, the eye care specialist may recommend dilating the patient’s pupils using eye drops. This allows for a more thorough examination of the eye’s internal structures and helps rule out underlying eye conditions.
Detailed Eye Examination: Novomed’s comprehensive eye examinations may include assessing the health of the eye structures, including the retina, optic nerve, and other vital components. This examination ensures a complete understanding of the patient’s eye health.
Specialized Testing: Depending on the individual case, specialized testing such as visual field testing, electroretinography (ERG), or other advanced diagnostic procedures may be conducted to gather additional information.

How is Strabismus Treated?

With Novomed’s advanced medical technology and our expert eye specialists, Strabismus can be treated through various methods depending on the condition’s type, severity, and underlying causes. The treatment goal at Novomed is to improve eye alignment, restore binocular vision (the ability to use both eyes together), and prevent or address related visual issues. Here are the main treatment options offered at Novomed:

Eyeglasses: In some cases, prescription eyeglasses may be prescribed to correct refractive errors (such as nearsightedness or farsightedness) contributing to Strabismus. Glasses can help improve eye alignment and visual acuity.
Vision Therapy: Vision therapy, also known as eye exercises or orthoptics, is a structured program of eye exercises and activities supervised by an optometrist or vision therapist. It is often conducted with children. Vision therapy aims to improve eye coordination and strengthen eye muscles to enhance binocular vision.
Eye Patching: Patching involves covering the dominant eye (the eye with better vision) to encourage the weaker eye to work harder and strengthen its function. This is commonly used to treat amblyopia (lazy eye) associated with Strabismus.
Atropine Drops: In some cases, atropine eye drops help temporarily blur the vision in the stronger eye. This encourages the weaker eye to become more active and may help improve alignment.
Botox Injections: Botulinum toxin (Botox) injections can be used to weaken specific eye muscles temporarily, particularly in cases of Strabismus that are not responsive to other treatments. This approach can help achieve better eye alignment.
Surgery: Strabismus surgery is often recommended when other treatments are ineffective or when the misalignment is severe. During surgery, an ophthalmologist adjusts the position of the eye muscles to realign the eyes properly. This may involve weakening or strengthening specific muscles, depending on the type of Strabismus.
Orthoptic Devices: In some cases, orthoptic devices, such as prisms or special lenses, may be used to manage Strabismus by altering the path of light entering the eyes and reducing double vision.
Treatment of Underlying Conditions: If Strabismus results from an underlying medical condition, such as a neurological disorder or systemic illness, addressing the primary condition may help improve or resolve the eye misalignment.

Book Your Appointment at Novomed Today!

Early diagnosis and intervention are crucial, especially in children, to maximize the chances of achieving the best possible outcomes and to prevent complications such as amblyopia. If you or someone you know has symptoms of strabismus, do not hesitate to book your consultation with one of our expert ophthalmologists in Dubai by calling 8006686, filling out the booking form or clicking the chat icon at the bottom of the screen.