Strabismus (squinting) : Causes, Symptoms and Treatment
What is strabismus
Strabismus, also known as squinting, is an eye defect in which the eyes do not look in the same direction. It occurs because the eye muscles do not work together properly, causing one eye to look straight ahead while the other eye deviates inward, outward, upward or downward. Strabismus can be continuous or occur only occasionally, as in latent strabismus, in which the deviation becomes visible only when fatigued or stressed.
This condition occurs in both children and adults and can cause problems with depth perception, double vision or, in young children, amblyopia (lazy eye). The cause of strabismus ranges from hereditary factors to neurological or muscular problems. Fortunately, several treatment options are available, including spectacle correction, eye muscle exercises and, in some cases, strabismus surgery to correct the position of the eye.
Symptoms of strabismus
Strabismus, also known as squinting, can cause different symptoms depending on the severity and type of abnormality. One of the most common symptoms is double vision (diplopia), especially in adults where the eyes do not work together correctly. Children with strabismus are less affected, as their brains often suppress the image of one eye, which can lead to lazy eye (amblyopia).
Other symptoms include blurred vision, headaches, difficulty with depth perception and a skewed head position to correct vision. Some people also experience eyestrain and eye strain, especially with prolonged reading or screen use. Strabismus can occur either continuously or occasionally, such as when tired or stressed.
Timely diagnosis and treatment are crucial to prevent complications such as permanent loss of depth perception or amblyopia.
Causes of strabismus
People see with both eyes. The images from both eyes are united in the brain into one image. This ability to see with both eyes develops in the child's first 6-7 years. If this development is disrupted, squinting can occur.
The causes of squinting in children are not always clear, but hereditary and environmental factors likely play a role:
Hereditary predisposition
Ophthalmic abnormalities
Refractive errors (e.g., high hyperopia), difference in strength between the two eyes
Medical problems in the period around birth
Brain nerve disorders, mainly cause of squinting later in life. A malfunctioning cranial nerve can also result from a variety of conditions, e.g., infarcts, diabetes, ...
Premature birth, smoking or drugs during pregnancy
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Different forms of strabismus
There are different forms of strabismus. In the most common form of squinting, convergent strabismus, one eye (sometimes both) turns toward the nose. In divergent strabismus, the eye faces outward. The eye can also be upward (sursumvergens) or downward (deosumvergens).
Squinting
Squinting occurs in about 2-5% of children and is more common after the first year of life. Their abnormal eye position is considered unsightly, so squinty children are often teased. However, it is not just an aesthetic problem. The main reason to detect and treat squinting at an early age is to prevent an eye from becoming lazy (amblyopia).
Lazy eye or amblyopia
When squinting occurs at an early age, the child rarely begins to double vision. The double vision is suppressed in the brain. If the image of the same eye is suppressed for a long time, this eye will not develop as well, causing the vision to deteriorate (= lazy eye) and certain details will not be clearly visible. When the eyes alternately squint, the chance of a lazy eye is small. A lazy eye does not heal by itself and can only be successfully treated in children up to about 7 years of age.
If squinting occurs after the eighth year of life, or in adulthood, then the brain's ability to suppress the abnormal image has been lost. Squinting then does not lead to lazy eye because the brain functions are already fully developed. Thus, the patient then does see double because the signals from both eyes are perceived separately.
Medical treatment of strabismus
Non-surgical treatment of strabismus: Spectacles and visual training
For the treatment of strabismus, there are nonsurgical options that can correct the position of the eye and improve the cooperation between the two eyes. The most common methods are spectacle correction and visual training, especially in children and mild forms of squinting.
1. Glasses and optical correction
In certain forms of accommodative strabismus, glasses with custom lenses can help correct the position of the eyes. Especially in children with farsightedness (hyperopia), glasses can cause the eyes to strain less, reducing squinting. In some cases, prism glasses are prescribed, which slightly shift the image so that the eyes work together better and double vision is reduced.
2. Eye patches and visual training
When strabismus is accompanied by amblyopia (lazy eye), an eye patch can be used on the strong eye to stimulate the weaker eye. This helps visual development and prevents further deterioration. In addition, visual exercises and eye muscle training can be used to improve coordination between the two eyes. These methods are often used in children, but can also be effective in adults in some cases.
These treatments are especially effective with early diagnosis and can sometimes eliminate the need for surgery. An ophthalmologist can determine which option is most appropriate based on the patient's individual situation.
Surgical treatment of strabismus
Surgical treatment of strabismus: Correction of the position of the eye
When nonsurgical treatments such as glasses and visual training are ineffective, strabismus surgery may be necessary to correct the position of the eye. This surgery is designed to strengthen, weaken or reposition the eye muscles so that both eyes work better together and are correctly aligned.
How does strabismus surgery work?
The surgery is performed under general or local anesthesia, depending on the age and complexity of the procedure. The ophthalmologist makes a small incision in the white part of the eye (sclera) and adjusts the eye muscles by:
- Weakening: The muscle is moved slightly backward so it pulls less.
- To strengthen: The muscle is shortened so it exerts more force.
- To move: Sometimes muscles are adjusted asymmetrically to correct squinting in specific directions.
The sutures dissolve on their own and the surgery usually takes 30 to 60 minutes.
Recovery and expected results.
Most patients experience mild redness, irritation and blurred vision in the first few days after surgery. Full recovery takes several weeks. In some cases, a second surgery is required for optimal correction.
Successful surgery not only improves eye alignment, but can also reduce double vision and improve depth perception. Final results depend on the severity of the strabismus and individual eye health.
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