Strabismus Treatment

Here are some frequently asked question about Strabismus treatment:

Q1. How is strabismus treated?

Q2. What happens in surgery for strabismus?

Q3. Any difference between surgery for children and adults?

Q4. You mean the surgery is repeated?

Q5. Then - bottom line - how effective is it?

Q6. Is there no alternative to surgery after orthoptic treatment?

Q7. What is the drug therapy?

Q8. Can ordinary prescription spectacles help?

Q9 What else might be used in orthoptics?

Q10. Are these exercises effective?


Q1. How is strabismus treated?
With early intervention. The first step is to determine the cause. This involves a careful refraction after the child's accommodation is prevented with atropine eye drops or eye ointment. Atropine also greatly widens the pupils, allowing full examination of the retinas to exclude serious internal eye disease. If the child is found to be hypermetropic, a full spectacle correction is ordered and these must be worn constantly, so as to prevent excessive accommodation. The straight eye must also be covered so as to force the child to use the suppressed eye. The management of restoration of vision and the promotion of full binocular vision is undertaken by an orthoptist - a person trained in the work and who works under the supervision of an ophthalmologist. When the vision has been restored to the squinting eye, the squint will commonly alternate between the eyes. This is a good sign. If the squint persists after that, surgery may be required. TOP

Q2. What happens in surgery for strabismus?
An ophthalmologist makes a small incision in the tissue covering the eye, to reach the eye muscle. Depending on which way the eye is turning, he or she then repositions certain muscles.

To correct esotropia, the ophthalmologist may place the inner eye muscles further back on the eye and shorten the muscle that turns the eye out. For exotropia, he or she may shorten the inner muscle and set the outer muscle further back. In either case the straight eye, the misaligned eye, or both may be operated on. Some ophthalmologists like to use adjustable sutures, which allow for some fine-tuning of the alignment after surgery. First, one or more muscles are repositioned with slipknot sutures. Then, usually within the next 24 hours, the muscle or muscles may be repositioned again by untying and retying the knots while the patient is under eye drop anaesthesia. In many cases no adjustment is needed, and the slipknots are converted to standard knots. TOP

Q3. Any difference between surgery for children and adults?
Not really. The principles are the same. In adults who have had strabismus since childhood, however, surgery is done for purely cosmetic reasons; in children (and those adults who have only recently developed strabismus) surgery is done to preserve vision. More than one operation may be needed. TOP

Q4. You mean the surgery is repeated?
Often it is. Even if the surgery succeeds in uncrossing the eyes, they may cross again. The procedure may have to be repeated to ensure that the eyes stay uncrossed. TOP

Q5. Then - bottom line - how effective is it?
Remember that surgery is only a part of the process of treating strabismus. Success depends on the care and effectiveness with which the vision in the squinting eye is brought up to normal. The results also depend on whether the squint is detected early enough. In children over the age of about seven it is unlikely that full vision will be restored. The younger the child at the time treatment starts, the better the outlook. In some cases particularly when the patient is older - the eyes are cosmetically uncrossed but vision remains double. In others, the young person may appear cosmetically satisfactory but may have permanent loss of vision in one eye - a condition known as amblyopia. TOP

Q6. Is there no alternative to surgery after orthoptic treatment?
Well, there is drug therapy.

Q7. What is the drug therapy?
The eye muscle can be injected with botulinum toxin-A to paralyse it temporarily, allowing the opposite muscle to tighten and straighten the eye. Although the effects of the drug wear off after several weeks, in some cases it may permanently correct the misalignment. TOP

Q8. Can ordinary prescription spectacles help?
Yes. If the condition is accommodative esotropia, the common form of strabismus that occurs in hypermetropic children, standard lenses known as 'plus lenses' correct the hyperopia and help the eyes to align. Sometimes bifocals are prescribed for close work. TOP

Q9 What else might be used in orthoptics?
Orthoptists may show the child how to do exercises designed to get him or her to use both eyes. The child may read, draw or follow a moving object with the eyes, looking through polarizing glasses that separate the sight in the two eyes. In this way the brain cannot rely on one eye alone but must practise using them both. TOP

Q10. Are these exercises effective?
Quite a high proportion of children treated by a skilled orthoptist attain full binocular vision. The secret is to achieve the full co-operation of the child and the parents when it comes to practising the exercises and occluding the squinting eye. Such treatment must be done by a fully qualified orthoptist working under an ophthalmologist. TOP