STRABISMUS: GENERAL INFORMATION AND SURGERY

General Information

Definition

Lack of coordinated muscle movement or focusing ability between the eyes, causing the eyes to point in different directions.  One or both eyes may turn inward (crossed eyes) or outward ("walleye").  Eye alignment is not fully mature at birth.  a true developmental eye drift typically shows up from birth to 3 or 4 months, but may occur in childhood or later.

Body Parts Involved

Eyes; brain area that controls vision

Sex or Age Most Affected

Both sexes; all ages

Signs & Symptoms

• Uncoordinated eye movements.  This is sometimes evident only when looking in certain directions.

• Double vision (sometimes)

• Vision in one eye only, with loss of depth perception.

Causes

In most cases, Strabismus is congenital (present at birth) and the cause is unknown.  Eye movement is controlled by brain signals to the four muscles around each eye.  Loss of coordinated movement results from :

• Muscle imbalance between the eyes

• Lack of equal focusing ability in the eyes. The brain cannot tolerate differing focused images, so it ignores signals from one field of vision.  The weaker eye eventually becomes useless from disuse, and a "lazy" or wandering eye results.

• Brain damage or head injury (rare)

Risk increases with

• Family history of Strabismus

• Down Syndrome

• Eye tumor

• Damage to fetal central nervous system

• Birth trauma

• Eye disuse

How to prevent

No specific preventive measures

What to expect

Diagnostic measures

• Your own observation of symptoms.  Note particularly if a young child covers one eye.  The may indicate the eyes are not focusing together.

• Medical history and physical exam by a doctor, including tests of visual acuity, retinal examination, total neurological exam and muscle tests.

Treatment

Treatment has 3 goals

• To obtain the best possible vision

• To gain the best eye alignment

• To provide the best opportunity for binocular vision

Treatment may include corrective glasses or an eye patch over the stronger eye to correct focusing imbalance (these force the weak eye to work), eye-muscle exercises, botulinum toxin (currently uses only in adults) or surgery to correct the condition of the eye muscles.  Sometimes a second operation is required. (See Strabismus Surgery in the Surgery section)

Optional therapy involves the se of eye glasses overlaid with thin plastic prisms.  These are used by the patient prior to surgery and help determine the amount of surgical adjustment needed on the eye muscles.

Possible complications

• Loss of normal vision in one eye

• Psychological distress from an unattractive facial appearance

Outcome

With early diagnosis, Strabismus can be corrected with glasses and an eye patch, eye exercises or surgery.  Without prompt treatment vision loss in one eye may become permanent.

 

How To Treat

General measures

• Carefully follow your doctor's instructions about the use of eye patches.  If you cover the good eye for too long a period, that eye may develop vision problems.

• Bandages are frequently unnecessary following surgery to correct Strabismus.  An antibiotic ointment is given to put in the child's eyes.

Medication

Medicine usually is not necessary for this disorder unless botulinum toxin injections are recommended.  They are injected into an  eye turning muscle, outside the eye, through and electromyographic needle.

Activity

No restrictions.   Protect your child against falls or injury while he or she adjusts to an eye patch.  No special diet.

Call your doctor if

Your child has symptoms of Strabismus.  Early diagnosis is vital to detect and treat underlying causes and prevent severe vision disability.

From the Complete Guide to Symptoms, Illness & Surgery by H. Winter Griffith, MD  © 1995 The Putnam Berkley Group, Inc; electronic rights by Medical Data Exchange.

STRABISMUS SURGERY

General Information

Definition

Surgery to strengthen or weakened the muscles that regulate horizontal movement of the eyeball.  The surgery will vary with the extent of the deviation of the movement and may be done in more then one operation

Body parts involved

Eyes

Reasons for surgery

Realign the eyes to restore single binocular vision and a balance in the appearance of the eyes.  The procedure is usually preformed in children while the eye is still developing to save vision in the affected eye.  In adults, the surgery is for cosmetic reason only.

Surgical risk increases with

• Known drug allergy

• Poor nutrition

What to expect

Who Operates

Ophthalmologist

Where performed

Hospital, outpatient surgical facility

 Diagnostic tests

• Before surgery: Special eye examinations to determine the amount of deviation.  Test performed will depend on the age of the patient.  (infant or an older child who can cooperate with instructions for visual testing.)

• After surgery: Eye examinations may be repeated as necessary.

Anesthesia

General anesthesia by injection and inhalation with an airway tube placed in the windpipe.

Description of operation

• The head is wrapped in sterile towels, leaving the eyes exposed.

• The eye muscle is exposed by cutting through the cojunctiva and fascia and a special instrument (called a squint hook) holds the whole width of the muscle

• If the muscle is to be lengthened, it is cut close to it's root and reattached with non-absorbable stitches to the surface layers of the eye at a distance determined by initial tests.

• If the muscle is to be shortened, it is cut close to it's root and a section is removed.  The two ends are then stitched together. 

• The fascia and conjunctiva are closed with stitches.

• A pad or shade may be placed on the eye.

Possible complications

• Inflammation of the conjunctiva

• Surgical-wound infection (rare)

• Bleeding

• Repeat surgery if further correction required

• Swelling  of the eyelid

Average hospital stay

0 to 1 day

Probable outcome

Expect complete healing and improved appearance without complications.  Allow about 2 weeks for recovery from surgery.

Postoperative Care

General measures

• Bathe and shower as usual

• Use a warm compress to relieve any pain, swelling or discomfort

• you may use non-prescription drugs, such as acetaminophen, for minor pain.  Avoid aspirin.

Activity

Rest until the effects of the anesthesia wear off.  The eye may water and be sensitive to light at first.

• Most normal activities can be resumed in about a week

• Avoid swimming for 10 days.

• Diet - no special diet

Call your doctor if

• Pain, swelling, redness, drainage or bleeding increases in the surgical area

• You develop signs or infection: headache, muscle aches, dizziness or a general ill feeling and fever

From the Complete Guide to Symptoms, Illness & Surgery by H. Winter Griffith, MD © 1995 The Putnam Berkley Group, Inc; electronic rights by Medical Data Exchange.

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The information on this website should not be used for medical advice.  Medical or health advice should be provided only by medical or health professionals.

©Craniosynostosis And Positional Plagiocephaly Support, Inc.2001