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Childhood is a critical period where the foundations of eye health are laid and visual ability rapidly develops. Strabismus (eye misalignment), which can occur during this period, is not merely an aesthetic problem; it is a serious condition that can lead to permanent vision problems if left untreated. As specialist ophthalmologists, we aim to raise awareness among parents regarding the early diagnosis and effective rehabilitation of strabismus and the resulting lazy eye (amblyopia) in children, and to provide our children with healthy vision.
Strabismus treatment in children is a process requiring a multidisciplinary approach and must be carefully planned according to the child’s age, and the type and degree of strabismus. The goal of this process is to achieve parallel alignment of the eyes, ensure coordinated working of both eyes together (binocular vision), and most importantly, prevent or treat amblyopia, which is permanent vision loss.
Table of Contents
What is Strabismus (Eye Misalignment)? Why Does It Occur in Children?
Strabismus is a condition where the eyes are not aligned, with one eye looking straight while the other deviates inward, outward, upward, or downward. Normally, both our eyes focus on the same point and send two separate images to the brain. Our brain merges these two images to form a single, three-dimensional image. In the case of strabismus, the brain may suppress the different image coming from the misaligned eye. Over time, this situation leads to a decrease in the vision ability of the suppressed eye, known as lazy eye (amblyopia).
Main Causes of Strabismus in Children
- Genetic Predisposition: A family history of strabismus increases the risk.
- Refractive Errors: Eye disorders such as high hyperopia, myopia, or astigmatism can cause strabismus. Hyperopia, in particular, is a common cause of inward deviation (esotropia).
- Imbalances in Eye Muscles: Weakness or over-action in one or more of the muscles that move the eyes.
- Neurological Problems: Conditions such as cerebral palsy, Down syndrome, or hydrocephalus.
- Congenital Causes: Strabismus present at birth and due to structural anomalies.
- Trauma: Head trauma or eye injuries.
- Other Eye Diseases: Conditions such as cataracts or eye tumors can also lead to strabismus.
Occasional eye deviation observed in infants during the first 3-4 months can be considered normal (“pseudo-strabismus” or appearance due to a flat nasal bridge). However, deviation that persists or becomes noticeable after the 6th month must be evaluated by an ophthalmology specialist.
Symptoms of Strabismus in Children: When to Consult a Doctor?
Careful observation by parents plays a critical role in the early detection of strabismus. It is important to consult an eye doctor without delay if one or more of the following symptoms are present in your child:
- Noticeable eye misalignment (constant or intermittent)
- Frequently closing or squinting one eye (especially in sunny weather)
- Tilting or turning the head to one side to look (abnormal head posture)
- Frequent eye rubbing or watering
- Complaint of double vision (can be expressed by older children)
- Difficulty grasping objects or perceiving distance
- Quick fatigue, headache during reading or near work
- White or bright reflection in the eyes in photographs (leukocoria) – This condition requires urgent evaluation.
Remember, early diagnosis significantly increases the chance of success in the treatment of strabismus and lazy eye!
How is Strabismus Diagnosed?
Strabismus in children is diagnosed through a comprehensive eye examination performed by an experienced ophthalmology specialist. The following assessments are conducted during the examination:
- Visual Acuity Tests: The visual level of each eye is measured using methods appropriate for the child’s age.
- Refractive Error (Need for Glasses) Assessment: Even hidden refractive errors are detected by widening the pupils with drops (cycloplegic refraction).
- Evaluation of Eye Movements: The movements of both eyes in all directions of gaze are examined, and muscle functions are assessed.
- Measurement of Strabismus Angle: The direction and degree of the deviation are determined using prisms or specialized tests.
- Binocular Vision (Two-Eye Vision) Tests: The ability of both eyes to work together and three-dimensional vision (stereopsis) are evaluated.
- Amblyopia (Lazy Eye) Investigation: It is checked whether there is a difference in vision between the eyes.
- Detailed Fundus Examination: The inner structures of the eye, particularly the optic nerve and retina, are examined for any underlying pathology.
Strabismus Treatment Methods in Children
The goal of strabismus treatment is not only to ensure that the eyes look aesthetically straight but also to achieve good visual acuity and coordinated functioning of both eyes together (binocular vision). The treatment plan is customized based on the cause, type, amount of deviation, the child’s age, and the presence of amblyopia.
| Treatment Method | Goals and Areas of Application |
|---|---|
| Glasses Treatment | The initial treatment option, especially for strabismus caused by refractive errors (hyperopia, myopia, astigmatism). The deviation may fully correct or decrease with regular use of glasses. It is also important in amblyopia treatment. |
| Patching Therapy | In the presence of lazy eye (amblyopia), the goal is to improve the visual ability of the weaker eye by covering the good eye for specific periods. The duration and frequency are determined by the doctor. |
| Orthoptic Treatment (Eye Exercises) | Special exercises applied to strengthen eye muscles, increase coordination between the two eyes, improve focusing ability, and support binocular vision. It is effective, especially in outward deviations and some specific types of strabismus. It can also be done with computer-assisted programs. |
| Prism Glasses | In some types of strabismus, especially in adults and children complaining of double vision, special prisms added to the spectacle lenses are intended to shift the image onto the deviating eye and prevent double vision. |
| Botulinum Toxin (Botox) Injection | In certain types of strabismus (e.g., strabismus due to sudden palsy, small residual deviations after surgery), botulinum toxin is injected into the eye muscles to temporarily weaken the muscle and achieve eye alignment. Its effect is temporary, but it may aid permanent correction or serve as an alternative/support to surgery in some cases. |
| Surgical Intervention (Strabismus Surgery) | In cases that do not correct with other treatment methods or high-angle deviations, the goal is to achieve eye parallelism by weakening, strengthening, or changing the direction of movement of the eye muscles. It is usually performed under general anesthesia. Glasses or additional treatments may still be required after the surgery. |
Orthoptic Treatment
Orthoptic treatment can also be defined as a kind of “eye physiotherapy.” This treatment consists of exercise sessions planned and applied by the ophthalmologist and orthoptist, requiring the child’s active participation.
Examples of Popular Orthoptic Exercises
- Pencil Push-ups: Based on the principle of focusing on the tip of a pencil and slowly moving it toward and away from the nose. It improves the eye’s ability to focus inward (convergence).
- Brock String Exercise: Performed using a string with different colored beads. One end of the string is held near the nose, and the other end is fixed. The child is asked to focus on different beads in turn. This exercise helps improve fusion (merging images from both eyes) and depth perception.
- Fusion Cards and Stereograms: Special pictures and devices that encourage three-dimensional vision and both eyes working together are used.
- Computer-Assisted Vision Therapy: Helps treat lazy eye and binocular vision problems through special software and games. Since it is fun, it can increase children’s compliance with the treatment.
Factors Affecting the Success of Orthoptic Treatment
- The child’s age and compliance
- The type and degree of strabismus
- The presence and severity of lazy eye
- Regular and correct performance of the exercises
- Active participation and support of the family in the treatment process
As a specialist vision therapist, we aim to achieve successful results in strabismus treatment by using the most current and effective orthoptic treatment methods suitable for each child’s individual needs.
Rehabilitation After Strabismus Surgery
Strabismus surgery helps the eyes become parallel by restoring the balance of the eye muscles. However, surgery is not the end of the treatment process but an important step. The rehabilitation process may continue during the postoperative period.
Post-Strabismus Surgery Care and Rehabilitation
- Doctor Check-ups: Regular check-ups after surgery are very important. The healing process and the condition of the eyes are closely monitored.
- Use of Eye Drops: Antibiotic and anti-inflammatory drops prescribed by the doctor should be used regularly.
- Use of Glasses: If glasses were used before surgery or if the need for glasses continues after surgery, they must be worn regularly.
- Additional Treatments: In some cases, patching therapy, orthoptic exercises, or prismatic glasses may be required for small residual deviations or lazy eye remaining after surgery.
- Recovery Period: Complaints such as redness, stinging, and watering in the eyes may occur after surgery. These symptoms decrease over time. Several months may be needed for full recovery and the final result.
Frequently Asked Questions About Strabismus Treatment
Q1: Can strabismus in children correct itself?
A1: Situations seen in the first few months of infancy, called “pseudo-strabismus,” or very mild, intermittent deviations may sometimes resolve spontaneously. However, strabismus that continues or is noticeable after the 6th month usually does not resolve on its own and must be evaluated by an ophthalmologist. Untreated strabismus can lead to permanent problems like lazy eye (amblyopia).
Q2: When should strabismus treatment be started?
A2: Treatment should be started as soon as strabismus is diagnosed. Early intervention (between the first 6 months and 2 years) is very important, especially in congenital strabismus and situations with a high risk of amblyopia. Starting treatment in the first 7-8 years, which is the critical period for visual development, increases the chance of success.
Q3: Is strabismus surgery risky? Does it recur?
A3: As with any surgical procedure, strabismus surgery carries some risks (infection, bleeding, anesthesia-related risks). However, these risks are quite low in experienced hands. Situations such as some residual deviation after surgery, under-correction, or over-correction may occur. In some cases, a second surgery may be necessary. The risk of strabismus recurrence varies depending on the type of strabismus, underlying causes, and compliance with postoperative treatment.
Q4: Can my child have lazy eye without eye misalignment?
A4: Yes, it is possible. Amblyopia can develop even without noticeable misalignment, especially if there is a high difference in prescription between the two eyes (anisometropia) or a slight, unnoticeable blur in one eye. This is why routine eye examinations are very important.
Q5: How long does strabismus rehabilitation take?
A5: The duration of rehabilitation varies depending on the child’s age, the severity of the strabismus and amblyopia (if present), the chosen treatment methods, and the response to treatment. Glasses may be needed long-term. Patching therapy can last months, or sometimes years. Orthoptic treatment is applied in sessions. The important thing is to patiently follow the treatment plan recommended by the doctor.
As Dr. Semrin Timlioğlu, we are here for you with all your questions regarding your child’s eye health and throughout the strabismus rehabilitation process. Remember, healthy eyes are our children’s window to the world, and early diagnosis and correct treatment are vital to keep these windows bright. You can contact us for detailed information and an eye examination appointment.
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