Our eyes are like image-taking cameras. The image of each object viewed is detected by two cameras and transferred to the visual center in the brain. In this center, these two images are superimposed, and are defined as a single image with the belief that they are the same. However, if both eyes are looking at different angles (strabismus), this image is not single, and the object seen by the non-slipped eye is perceived as double (diplopia).

Is Double Vision / Diplopia Important in Strabismus Patients?

Diplopia is a very uncomfortable condition. It literally ruins one's life. This double vision is tried to be eliminated by the suppression mechanism in children. In other words, the vision of the deviated eye is suppressed and the deviated eye becomes less able to see over time. This is called lazy eye (amblyopia). However, this does not apply to adults. The problem of double vision cannot be solved without bringing both eyes to the midline and eliminating strabismus.

What Problems Cause Strabismus in Children?

Eye movements act with the upper, lower, internal, external rectus muscles and lower-upper oblique muscles. Strabismus occurs in problems related to these muscles. It is the visual function that keeps both eyes in the midline. The eye with low vision tends to slide inward in a pediatric patient and outward in an adult patient.

Image-1: Strabismus in children

Therefore, visual acuity is very important. Significant results can be obtained from the inteferance for amblyopia, especially in children up to the age of 9 (the development of the visual pathways is not completed until the age of 9). Vision can be increased. However, if the age of 9 is exceeded, nothing to be done will contribute to the treatment of amblyopia.

What to Do for Children with Strabismus?

Newborn strabismus is often independent of refractive changes. However, refractive errors in infantile (childhood) strabismus, especially hyperopia, are very effective in the development of strabismus. If the child with a refractive error also has amblyopia, this refractive error should be eliminated and the child should be given appropriate glasses. Eyeglass lens detection should be determined by examination with cycloplegia, and glasses that make the child see the best should be preferred. Sometimes prismatic glasses can also be used. For the determination of vision level, visual charts consisting of special shapes are used under the age of 4, and E chart is used for the 4-6 age group. A precise determination of the child's vision level is very important. Detection of visual acuity is also vital in terms of amblyopia follow-up and management of the treatment process.

Surgical Treatment of Strabismus

The treatment of strabismus that does not improve with glasses is surgery. In the deviating eye, the muscle in the direction of the slippage is weakened, while the muscle in the opposite direction is strengthened. Recession (shortening the length of the muscle) surgery is performed to strengthen the muscle, while regression (the attachment of the muscle is taken further back) surgery is performed to weaken the muscle. The main goal in strabismus surgeries is to bring the eye to the midline. However, even if the strabismus is completely eliminated in an eye with very low visual acuity, it will tend to slide again after a while. For this reason, if a problem that can be solved prevents vision, the first challenge should be to increase visual acuity.

What to Do in Paralytic Strabismus Due to Eyebrow Paralysis?

Some of the strabismus may also be caused by paralysis of extraocular muscles (extra ocular muscles). Muscle paralysis can be congenital as well as later. Subsequent events may also occur with intracranial events (trauma, bleeding, tumor, vascular occlusion) or metabolic changes (diabetes, kidney failure, liver failure, A avitiminosis, heavy metal poisoning). Metabolic cases are often temporary. However, strabismus caused by other reasons is usually permanent. Among these, those secondary to trauma may recover. Therefore, at least 6 months should be waited after trauma. In permanent ones, support can be provided from other muscles (transposition surgery, paralytic muscle surgery) to support the paralyzed muscle.