Strabismus is a disorder that is more common in children but also occurs in adults. If left untreated, it not only affects the person’s eye health , causing the quality of life to decrease and the inability to perform some professions, but also prevents them from socializing due to aesthetic concerns.
So, what causes strabismus, one of the oldest known disorders ? What are the types of strabismus? By what methods is strabismus , also called eye misalignment , treated? Will an untreated strabismus go away on its own over time? The answers to all these questions are given under the relevant subheadings below.
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Causes of Strabismus
Although the exact cause cannot be stated, it is possible to mention some factors that cause strabismus :
The eyes move with the synchronized work of six muscle groups, two of which are oblique and four rectus muscles. The reason why strabismus usually occurs is the disruption of harmony between these muscles, whose strength increases or decreases. Also, some diseases that affect the control center area of these muscles in the brain (such as hydrocephalus, Down syndrome, cerebral palsy) also cause eye misalignment .
High fever and accidents in childhood, etc. Strabismus may also occur after trauma. In addition, if the eye has a refractive error such as hypermetropia and is advanced, this may cause eye misalignment when the child tries to clarify the vision.
Some diseases experienced by an expectant mother during her pregnancy may also cause strabismus in the baby . Additionally, the baby is born prematurely or with low birth weight, has a seizure, or experiences some postnatal trauma, which are also among the causes of eye misalignment .
Common causes of strabismus include structural disorders (neurological, functional or abnormal conditions in the muscles) and some eye-related disorders (such as glaucoma, cataracts). Strabismus may also be a reflection of high blood pressure, diabetes, and some tumors that develop in the brain or inside the eye (Strabismus, which appears suddenly, requires detailed examination, as it may be a sign of the presence of a tumor).
Apart from all these reasons, it is known that genetic factors play a role in strabismus. Although there is a high risk of inheriting eye strain from the next generation, strabismus does not occur in every child who has a strabismic member(s) in their family .
Types of Strabismus
Strabismus has been classified in different ways by approaching it from different angles.
Nonparalytic and paralytic strabismus, whether there is muscle paralysis (stroke) or not; non-accommodative, accommodative and partially accommodative strabismus , based on the relationship of strabismus with accommodation (the function of the eyes to adapt and focus); monocular and alternating strabismus, whether the deviation is always seen in one eye or in one right and one left eye; constant and intermittent strabismus, whether strabismus is always present or not; congenital and acquired strabismus, age of onset of strabismus; comitant and incompatible strabismus, depending on the angle of deviation (whether it changes according to the direction of gaze); Manifest and latent strabismus are classifications made by looking at whether the strabismus is clearly noticeable from the front.
Apart from these classifications, there is also a classification based on the direction of strabismus . Accordingly, eye deviations are divided into groups as inward, outward, upward, downward and others.
Eye Turning Inward (Esotropia)
Among the types of strabismus performed by looking at the direction of deviation, the most common one in children is inward deviation. Strabismus in this group, also called esotropia , is encountered in approximately half of the strabismus cases seen in childhood (especially in children between the ages of 1.5 and 4) .
Non-accommodative, accommodative and partially accommodative are prominent among the types of esotropia. When the eye shifts inwards , there is a high probability that hypermetropia refractive error will also exist. Esotropia that develops due to hypermetropia is called accommodative esotropia , and such inward shifts are encountered more frequently than other types.
Treatment with glasses is the first method used in accommodative esotropia . If the shift continues, even partially, despite treatment with glasses, this is called partial accommodative esotropia . Even if the refractive error is corrected with glasses, if there is no regression in the inward deviation of the eyes, there is non-accommodative esotropia .
Even though there is no refractive error, inward deviation of the eye may occur. Especially in adults, esotropia caused by nerve paralysis may be encountered. These patients can be treated with neurotoxin injection.
Inward shifts that appear until the baby is 6 months old are defined as infantile esotropia (congenital inward slippage). (Infantile esotropia can sometimes occur between 6-12 months). This type of strabismus can be corrected by surgical intervention before the baby reaches the age of 2, because binocular vision can only be achieved with this method. In other words, treatment with glasses is often inadequate for such cases.
Extraverted Eye (Exotropia)
Exotropia , that is, turning the eye outward, is less common than inward turning . It occurs during childhood (especially over the age of 5).
Exotropia , which can be seen in one or both eyes, is often accompanied by fatigue, etc. Although it may occur intermittently for various reasons, it may also be chronic. It is often observed that it increases when the patient looks away. It is possible that outward deviations of the eye may not be clearly noticed by the patient, but may attract the attention of others.
There are different types of eye deviations . Intermittent exotropias (intermittent) usually appear at the age of 2 and are more prominent in school-aged children (around 7 years of age) and develop without any eye disorder.Surgical intervention is preferred for treatment when intermittent outward movements, which usually become evident when the person is sleepy or tired,
There is also a congenital type of exotropia other than intermittent outward shifting (rarely seen). As with congenital introversion , congenital extroversion usually occurs before the baby reaches the first 6 months. It is divided into chronic or occasional. Outward shifts , which occur from birth, are chronic and can cause amblyopia .
Upward Shift of the Eye (Hypertropia)
Although it is rare, eye deviation , called hypertropia , can be a symptom of serious disorders such as 4th nerve palsy (which stimulates the superior oblique muscle), tumors in the eye socket, and goiter. Apart from these, it may exist from birth without any known cause or may occur due to trauma.
There is also the possibility that latent strabismus may increase in the future and cause hypertropia . A detailed investigation of the underlying cause is essential both to determine the correct treatment method and to increase the chance of eliminating the disease. Especially in cases where double vision increases, surgical treatment is usually used.
Hypertropia can be seen in some or all gaze positions . Although it is mostly seen in one eye, in some cases both eyes may be affected. Problems with vertical alignment are common in the presence of hypertropia . If the shift occurs due to 4th nerve palsy, it increases when the head is tilted to one side.
Eye Shift Down (Hypotropia)
Both downward and upward deviation of the eye are rare types of strabismus . Such shifts, called hypotropia , may occur due to various reasons (such as orbital floor fracture, Graves’ disease).
Patients who experience eye deviation should be examined in detail, and the appropriate treatment method should be selected after determining what causes the deviation.
Other Shifts Classified According to Strabismus Direction
Inward and outward deviations of the eye, horizontal; Up and down shifts are called vertical shifts. Apart from these, there are also torsional and combined slides. Torsional shifts are in an inward or outward rotational direction. In combined slides, as the name suggests, slides in different directions occur together.
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Strabismus Treatment Methods
Improving the vision levels of the eyes, making binocular vision possible, and improving the external appearance that causes aesthetic concern are among the main purposes of strabismus treatment . Different treatment methods are applied to achieve this goal .
There are some factors that affect the high success rate of treatments. Examples of these factors include the age of the patient (the chance of response to treatment is higher at younger ages), whether there is another health problem with the eyes, how long after the symptoms appear, the patient’s general health condition, the degree of strabismus and when it started.
The treatment method and duration are determined after a detailed examination of the patient. If the findings show that there is a refractive error along with strabismus (strabismus is caused by a refractive error), the patient must wear glasses with an appropriate degree. Similarly, if the patient has amblyopia, occlusion treatment (closing the healthy eye at the frequency and length recommended by the physician) can also be used.
Surgery is another method of strabismus treatment . It can be preferred as the first method in both babies and adults when deemed necessary by the physician. In surgeries, the muscles responsible for the movements of the eyes are intervened. Therefore, laser is not used.
Does strabismus go away on its own?
There is no possibility of a strabismus that is not treated to go away on its own. What causes the opposite to be commonly thought is false strabismus . False strabismus seen in babies is an illusion, as its name suggests. It is the width of the baby’s nose root that gives the feeling of misalignment in the eyes . Since this illusion disappears as the baby develops, a false belief has arisen among the public that strabismus disappears on its own.
On the other hand, not all strabismus seen in babies is pseudostrabismus. For this reason, routine eye screenings of the baby should not be interrupted and a specialist should be consulted, especially if the eyes are misaligned and there are people in the family diagnosed with strabismus . However, it should not be forgotten that the earlier the treatment is started, the higher the success rate.
A patient diagnosed with strabismus , whether a child or an adult, has no chance of recovery without treatment. As mentioned, treatment should be determined according to the underlying factor and applied at the right time by the right specialists.
Untreated strabismus is not likely to go away on its own and may cause amblyopia , etc. It should not be forgotten that it will bring with it problems and negatively affect both the immediate and future life of the patient.
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