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Child Ophthalmology Unit

What is Strabismus?

Strabismus is the state in which both eyes do not look at the same direction and act parallelly. While one eye looks straight, the other may look inward, outward, up and down. This is called strabismus.

Muscles outside the eye ensure its movement. These muscles provide focus continuously moving the eyes in harmony. One or more of these muscles not to do their duties well results in strabismus.

Infants experience the foveal fixation on the first 6 months and occasional cross-eye is normal during this period. Because, infants do not develop the capability of perceiving with two eyes which holds their eyes parallel during the mentioned period. These cross-eye situations must certainly be evaluated by an ophthalmologist following this period. Therefore, early eye examination and scanning are all important.

The states of inward cross-eye following the sixth month are called infantile esophoria and these are wide-angle strabismus which does not require glasses in general and their treatment is surgical. The idea of undergoing operation when children grow old has changed in our day in our country and the developed countries and the idea of operation at the earliest time under the age of 1 in case of inward cross-eye and above the age of 4 in case of outward cross-eye.  

There are types of hidden strabismus other than inward, outward, upward and downward strabismus which are common in the society. Here, strabismus occurs when one of the eyes is closed. Through a connective mechanism, brain ensures eyes to stay parallel when both eyes are open. But when one of the eyes is closed, this mechanism breaks and strabismus occurs in the closed eye. Patients are not aware of the strabismus in general.

Patients apply with the complaints such as feeling of tiredness in eyes, redness, pain, xerophthalmia and headache. In visual impairment, these complaints occurs earlier if available and patients complaint about headache particularly in close reading. A part of the strabismus cases seen in the infantry and childhood periods are the cases of pseudostrabismus.  

Pseudostrabismus is a misleading appearance occurring with the width of eyelids and nasal root. In order to illuminate this completely, an eye examination must certainly be made.

What are the Causes of Strabismus?

1) Genetic

2) Not using glasses even if it is needed

3) Abnormalities in muscles moving the eye

4) Neurological and congenital problems (Situations like down send and cerebral palsy)

High blood pressure, diabetes mellitus in advancing ages, trauma, tumor, some infectious diseases, intoxications.

Strabismus Symptoms

1) Strabismus in one eye (the most typical symptom),

2) Head leaning and face turning to one side (to use both eyes),

3) Sensitivitiy against light,

4) Closing one eye during reading,

5) Double vision, headache and tiredness.

It is necessary enhance visual acuity, adjustment of abnormal head position, recovering of double vision, ensuring free movements of eyes and removing of cosmetic complaints.

Refractive error must be corrected primarily.

Amblyopia must be treated if available. Otherwise, the brain learns not to take the vision in the cross-eye into consideration and this causes to a loss in the feeling of depth and amblyopia. In adults, double vision occurs due to brain has learned to perceive the visions from both eyes.

How is Strabismus Treated?

1) Some types of strabismus depend on the refracture error and the state of cross-eye is adjusted during the use of glasses.

2) In case of amblyopia, the relevant eye is closed.

3) Congenital strabismus does not require glasses in general and needs to be operated in the early period (6 months-1 year). A great part of the strabismus cases ingenerates aroud the ages of 2-3 and is healed with glasses    completely. And cases not healed despite wearing glasses require surgical intervention.

4) Botox is influential and can be used as a treatment in:

- Paralysis dependent strabismus cases,

- Patients who were operated but could not be healed,

- Goitre dependent strabismus cases.

Double vision occurs generally in paralysis dependent sudden strabismus cases and this is very hard for patients. The general tendency must be expected for 6 months in such cases. But botox can be applied on the purpose of reducing double vision in this period.

What is Amblyopia?

While distinguishing silhouettes, the newborn infants learn color and three dimensional vision on the 6th month. Amblyopia is the state in which one eye has lesser sight capacity than the other. This is a sight loss starting during the childhood period, in which the sight functions could not be completed yet, that becomes permanent but it is preventable. Therefore, eye examination in the early period and scannings are influential in early diagnosis.

Causes of Amblyopia

1) Strabismus; sight in crossed eye gradually decreases because of not being used

2) Need for glasses; the glasses therapy must start at the early period

3) Congenital cataract, states preventing sight such as looseness of eyelid

Amblyopia Treatment

1) Adjustment of refraction error

2) Closure treatment (the most influential treatment)

The treatment results would be more successful as long as the closure procedure starts earlier. The closure treatment can be applied up to the age of 12.

What is Nystagmus?

It is defined as the involuntary movements which are defined as the rhythmical vibration of eyes.

Nystagmus Diagnosis

It is diagnosed according to

1) Whether or not a definite looking position occurred,

2) Decrease or disappearing of the nystagmus with the near or distant head position.

Nystagmus Treatment

Firstly, the level of sight must be increased with appropriate glasses.

Surgical treatment; but the success rate is not as high as strabismus.

Eyes must certainly be examined by a specialist physician right after birth for visible and invisible disorders and must be treated if required.