Strabismus: What It Is, How It Affects Vision, and What You Can Do About It

Welcome to today's video where we'll dive deep into the topic of strabismus, a condition more commonly known as being "cross-eyed." Strabismus is not just a cosmetic issue; it can have significant impacts on vision if left untreated. In this article, we'll explore what strabismus is, the different types, how it affects vision, and what treatment options are available. And as a bonus, toward the end, I'll share a fun trick I use to make my eyes appear cross-eyed, even though they aren’t—so stay tuned!

Introduction: Who We Are and Why Strabismus Matters

Hi there! I'm Dr. Allen, host of the Dr. iel Show, where we delve into all things related to eye health, vision care, and the best products to support your eyesight. If you're passionate about taking care of your eyes and want to learn more about how to keep them healthy and functioning at their best, consider subscribing to our channel. Don’t forget to ring the notification bell so you never miss a new video!

Now, let's imagine you're a parent taking your child to an eye exam. The doctor mentions that your child has an eye that occasionally turns inward, a condition referred to as strabismus. They might also mention terms like "lazy eye" or "esotropia," leaving you feeling unsure of what these terms mean. Understanding strabismus is crucial, as early detection and treatment can significantly improve outcomes for your child's vision. Let's break down everything you need to know about strabismus.

What is Strabismus?

In the world of eye care, strabismus refers to a condition where the eyes do not properly align with each other when looking at an object. Instead of both eyes focusing on the same point, one eye may turn inward (esotropia), outward (exotropia), upward (hypertropia), or downward (hypotropia). Strabismus can be constant, where the eye turn is always present, or intermittent, occurring only some of the time.

This misalignment can lead to a variety of vision problems, especially if not addressed early in life. This is why regular pediatric eye exams are so important. Many vision screenings, such as those done in schools or at pediatricians' offices, may miss strabismus, particularly if the eye turn is subtle. If your child has not had a comprehensive eye exam, or if you've noticed any signs of an eye turn, it's essential to have them evaluated by an eye care professional.

The Different Types of Strabismus

Understanding the different types of strabismus can help you better grasp what might be going on with your or your child’s eyes. Our eyes are designed to work together, moving in unison like the wheels of a car. When you look left, both eyes should move left; when you look right, both should move right. However, with strabismus, one eye may not follow the other properly. Here’s a breakdown of the different types:

1. Esotropia: This occurs when one eye turns inward while the other eye is focused straight ahead. "Eso" refers to the inward direction.

2. Exotropia: In this case, one eye turns outward while the other eye remains focused straight ahead. "Exo" refers to the outward direction.

3. Hypertropia: This is when one eye is higher than the other. "Hyper" denotes the upward deviation.

4. Hypotropia: The opposite of hypertropia, hypotropia occurs when one eye is lower than the other. "Hypo" refers to the downward deviation.

It’s also possible for someone to have a combination of these deviations. For example, an eye may be both turned inward and upward, a condition known as "esotropia with hypertropia." In the clinic, we measure the degree of deviation using prisms and quantify it in prism diopters. For instance, a patient might have "20 prism diopters of esotropia." We also specify which eye is affected (right, left, or both) and whether the condition is constant or intermittent.

Why Early Detection Is Crucial

Strabismus can lead to serious vision problems if not treated early, the most significant being amblyopia, commonly known as "lazy eye." Amblyopia occurs when the brain starts to favor one eye over the other, leading to poor vision in the affected eye. This happens because the brain, in an effort to avoid double vision (diplopia), suppresses the image from the misaligned eye. Over time, this suppression can result in the brain essentially "turning off" the weaker eye, causing permanent vision impairment if not addressed.

This is why early detection and treatment of strabismus are so important, particularly in young children. The brain's ability to adapt and develop normal vision—what we call neuroplasticity—is much stronger in childhood, especially up to the age of 8 or 9. Beyond this age, the chances of fully correcting vision problems like amblyopia decrease significantly.

What Causes Strabismus?

Strabismus can be congenital (present at birth) or acquired later in life. Here’s a closer look at the causes:

1. Congenital Strabismus: Often, children are born with strabismus or develop it in infancy. For instance, a child may have an eye that is constantly turned inward (esotropia) from birth or early development. Typically, by the age of 6 months, a baby’s eyes should be well-aligned. If an eye turn persists beyond this age, it's crucial to have the child evaluated by an eye care professional.

2. Accommodative Esotropia: This type of strabismus occurs in children aged 2 to 3 years, a time when they begin to focus more on near objects, such as toys. Children with hyperopia (farsightedness) are particularly at risk. Their eyes must work harder to focus on near objects, which can cause the eyes to turn inward. This condition illustrates how interconnected our eye muscles and focusing mechanisms are. The muscle inside the eye that helps it focus, called the ciliary body, is linked to the muscles that control eye alignment. When these muscles work too hard to focus, they can inadvertently cause the eyes to cross.

3. Acquired Strabismus: Strabismus can also develop later in life due to various factors. Trauma, such as a head injury, can damage the nerves controlling the eye muscles, leading to strabismus. Medical conditions like severe diabetes, high blood pressure, or neurological issues like brain tumors or aneurysms can also cause acquired strabismus. In these cases, the condition is often referred to as "paralytic strabismus" because the eye muscles are paralyzed or weakened due to nerve damage.

Symptoms of Strabismus

The symptoms of strabismus can vary depending on the type and severity. In young children, the condition often goes unnoticed because the brain adapts by suppressing the image from the misaligned eye, preventing double vision. However, adults who develop strabismus later in life are more likely to experience double vision, as their brains are less adaptable.

Other common symptoms include:

• Misaligned eyes: One eye may appear to wander or be misaligned.
• Difficulty with depth perception: Trouble judging distances, leading to clumsiness or accidents.
• Squinting or closing one eye: Often done to improve focus or avoid double vision.
• Head tilting: To compensate for the misalignment and improve vision.

Treatment Options for Strabismus

Treatment for strabismus varies depending on the type, severity, and underlying cause. Here are some of the most common treatment options:

1. Glasses: For children with accommodative esotropia, glasses that correct farsightedness can often correct the eye turn. The lenses reduce the eye's need to work so hard to focus, which in turn can help the eyes align properly.

2. Patching and Atropine Drops: To treat amblyopia (lazy eye), doctors often recommend patching the stronger eye to force the weaker eye to work harder. This can help improve vision in the weaker eye. Atropine drops, which blur the vision in the stronger eye, can also be used as an alternative to patching.

3. Prism Lenses: For adults with strabismus, prism lenses can be incorporated into glasses to help align the eyes and reduce double vision. Prisms work by bending light, which helps align the visual images seen by each eye.

4. Vision Therapy: Vision therapy, also known as orthoptics, involves exercises designed to improve the coordination and focus of the eyes. This therapy can be helpful, particularly for those who develop strabismus after a traumatic brain injury. While not always effective in severe cases, it can be a useful tool in conjunction with other treatments.

5. Surgery: For many people, especially those with significant or congenital strabismus, surgery may be necessary to realign the eyes. Strabismus surgery involves adjusting the eye muscles to correct the alignment. Surgery is often most successful when performed at a young age, but it can also be beneficial for adults, particularly for cosmetic reasons or to reduce double vision.

The Psychological Impact of Strabismus

Beyond the physical and visual challenges, strabismus can have significant psychological impacts, especially in children. Kids with noticeable eye turns may face bullying or social isolation, which can affect their self-esteem and emotional well-being. Adults with strabismus may also experience anxiety or embarrassment in social situations. This is why, in some cases, strabismus surgery or other treatments are pursued not just for functional reasons but to improve quality of life and social interactions.

Psychosocial Considerations in Strabismus

Children with strabismus are at a higher risk of experiencing bullying or teasing from their peers, which can lead to social withdrawal, lower self-confidence, and even academic difficulties. This is particularly concerning because these social and emotional impacts can persist into adulthood if not addressed. Parents and caregivers should be aware of these potential challenges and seek not only medical treatment but also emotional support for their child.

In adults, the psychosocial impact of strabismus can be equally profound. Adults with noticeable strabismus might avoid eye contact or feel self-conscious in social and professional settings. This can lead to a reluctance to engage fully in social interactions, potentially affecting relationships and career prospects. For this reason, some adults opt for surgery even if their strabismus doesn’t significantly impact their vision, simply to improve their confidence and appearance.

Living with Strabismus: Coping Strategies and Support

For those living with strabismus, especially if it has been present since childhood, developing coping strategies is essential. Here are some tips:

1. Educate Yourself and Others: Understanding your condition can empower you to explain it to others, reducing misunderstandings. Education can also help you advocate for yourself in medical and social situations.

2. Join a Support Group: Connecting with others who have similar experiences can be incredibly beneficial. Whether online or in-person, support groups provide a sense of community and a space to share tips and stories.

3. Communicate Openly: If you feel comfortable, discuss your condition with friends, family, or colleagues. This can help others understand any challenges you might face and reduce any awkwardness or stigma associated with the condition.

4. Focus on the Positives: While living with strabismus can be challenging, it’s important to focus on what you can do rather than what you can’t. Engaging in activities you enjoy and surrounding yourself with supportive people can help maintain a positive outlook.

Fun Trick: How to Make Your Eyes Look Cross-Eyed

As promised, here's a fun little trick you can try at home to make your eyes appear cross-eyed, even if you don't have strabismus. This trick is completely harmless and can be a fun party trick or just something to amuse yourself with in front of a mirror.

1. Find a Small Object: Start by finding a small object that you can hold up close to your nose, like a pen or your finger.

2. Focus on the Object: Hold the object about 6 inches away from your nose. Focus your eyes on the object as you slowly bring it closer to your nose.

3. Cross Your Eyes: As the object gets closer, your eyes will naturally start to cross in an attempt to maintain focus on the object. At a certain point, you'll see your eyes appear crossed in the mirror.

4. Hold the Position: Once your eyes are crossed, you can try holding the position for a few seconds. It might feel a bit strange, but with practice, you can control how long you hold the cross-eyed look.

Remember, this is just a fun trick, and while it might look similar to strabismus, it's not the same. Strabismus is a medical condition that requires proper diagnosis and treatment by an eye care professional.

Conclusion: Take Action for Better Eye Health

Strabismus is a complex condition that can affect people of all ages. Early detection and treatment are key to preventing long-term vision problems and improving quality of life. Whether through glasses, surgery, or other interventions, addressing strabismus can help align not only your eyes but also your life.

If you suspect that you or your child may have strabismus, don’t hesitate to reach out to an eye care professional. A comprehensive eye exam is the first step toward understanding the condition and exploring treatment options. And remember, if you found this information helpful, please like, share, and subscribe to our channel. Your support helps us continue to provide valuable content on eye health and vision care.