What is it?

What exactly is strabismus?

The squint (strabismus) is a relatively common condition that normally occurs at a young age. The condition is that the optical axes of the two eyes are not parallel. The strabismus degree varies from a few degrees, often not even perceived by parents, to many, which directly disturbs the environment of the young patient. The angle of strabismus is sometimes stable and sometimes ranging from minimal to significant.

strabismus1   strabismus2

A squint, apart from the aesthetic problem posed, has significant effects on the overall functioning of vision. A squint eye gradually loses its ability to distinguish anything clearly and ends up practically useless. Apart from that, even where there is no vision decrease (where both eyes squint rotatingly), the patient loses the ability to see stereoscopically, i.e. to understand the dimension of depth. When there is suspicion of strabismus a proper eye examination is necessary, so that, on the one hand the occurrence ratio of strabismus is established and, on the other hand, to promptly determine the appropriate treatment.

Causes

What are the main causes of the disease?

The main causes are heredity, some brain diseases and systemic diseases (diabetes, thyroid). Usually childhood strabismus is due to refractive problems. In rare instances, however, it may be due to other ocular pathology or even neurophthalmological diseases. Besides childhood strabismuses there are also strabismuses that appear in old age. These are rare and are typically due to pathological causes or trauma.

strabismus3   strabismus4

Strabismus types

There are several types of strabismus:

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  • esotropia (convergent squint): when one eye escapes inwards
  • exotropia (divergent strabismus): when one eye escapes outwards
  • anotropia: when one eye escapes upwards
  • hypotropia: when one eye escapes downwards
  • rotational strabismus: when the eye rotates inwards or outwards
  • manifest / latent strabismus (-tropia and -phoria)
  • continuous / intermittent strabismus
  • coherent / incoherent strabismus
  • unilateral / alternating strabismus
  • paralytic strabismus

Treatment

How is strabismus treated?

Treatment aims to restore and maintain good vision and the alignment of both eyes. The main modes of response, depending on the age of the patient, are:

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  • glasses
  • coating technique
  • prismatic lenses
  • Botox injections
  • surgical repair
  • Refractive surgery by laser (excimer laser)
  • combination of the above

Surgery

How is surgery performed?

During strabismus surgery, the surgeon attempts to weaken or strengthen some extraocular muscles (responsible for the position and movement of the eyes). These muscles behind the eye (starting from the back wall of the orbit), then march forward and "embrace" the eye and eventually overgrow ("stack on") onto the sclera ( the white part of the eye). There are different techniques the surgeon selects each time, to achieve the result pursued. The preoperative planning of the surgery is very important, although several times intraoperative adjustments are required.

strabismus9   strabismus10

Surgery is performed fine tools minutes and it lasts from 45 to 60 minutes, depending on the case. In children general anesthesia is required, and in adults there is the option of local anesthesia with anesthetic drops. Hospitalization is usually one day. Postoperatively, the whites of the eyes (sclera) are red on points the incisions were made, but after a few weeks the redness subsides with the help of local antibiotic / anti-inflammatory drops as well.