What is Strabismus?
Strabismus, commonly referred to as “crossed eyes” or “lazy eye,” is a visual condition characterized by an improper alignment of the eyes. In individuals with strabismus, the eyes do not work together as a coordinated pair, causing one eye to be misaligned relative to the other. This misalignment can be constant or intermittent and can affect one eye or both eyes.
Adult Strabismus is a misalignment of the eyes, which may or may not produce double vision.
For those with the potential for 3D (binocular vision), this misalignment causes loss of 3D vision, and in some cases treatment is restorative.
While most cases of strabismus occur in childhood and are most often managed by pediatric ophthalmologists, most adult strabismus is of different causation and thus management of adult strabismus is quite different from that of childhood strabismus.
Symptoms of Strabismus
- New onset of strabismus warrants urgent evaluation.
- Strabismus may present as double vision, or as an eye turning in, out, up or down. This may occur all the time or may be intermittent, and may affect one or both eyes.
- Improper eye alignment may cause double vision, poor depth perception, or difficulties in social interactions.
- Untreated strabismus may worsen, leading to greater difficulty in correction or may lead to permanent loss of binocular potential. Consulting a specialist is recommended in all cases of strabismus.
Our specialists evaluate strabismus through examination and other assessments that measure eye movement, alignment and focus. Tests may include the following:
- Patient history. Family history, general health issues, medications, environmental factors.
- Visual acuity test. Use of eye chart test to measure distance sight.
- Refraction. Determination of the appropriate corrective lens power for glasses.
- Alignment and focusing testing. Assessment of issues affecting ability to focus or eyes to move together (sensorimotor evaluation).
- Examination of eye health. Tests to uncover any underlying disease that could be contributing to the strabismus.
- Visual field testing. At times, underlying disorders which present as strabismus may be associated with partial loss of vision or peripheral vision.
- Optical Coherence Tomography. At times, underlying disorders which present as strabismus may be associated with abnormalities in optic nerve or retinal structure or function.
- Photography. At times, evaluation of fundus photography and external photography are of assistance in evaluation of strabismus.
- Ultrasonography. In office, ophthalmic ultrasound may be used to screen for or assess conditions which may contribute to strabismus, such as orbital inflammatory disease, masses or circulatory disorders.
- Blood studies. Blood studies may be suggested to screen for systemic disorders which may present with strabismus.
- CT and/or MRI. At times CT and/or MRI are helpful in evaluating causes or contributing factors.
People with strabismus have several treatment options to improve eye alignment and coordination. Strabismus can often be treated with excellent results.
Some considerations for treatment are:
- Frequency of occurrence—either constant or intermittent
- Involvement of the same eye—unilateral
- Affecting both eyes—alternating
- Glasses / contact lenses. Some patients may only require this kind of corrective treatment.
- Prism lenses. These special lenses reduce how much the eye turns to view objects and in some cases prism lenses can eliminate eye turning altogether.
- Optometric therapy. Occasionally, orthoptic treatment and/or optometric therapy may reduce strabismus, or may be helpful to improve the result of a surgical treatment
- Strabismus surgery. Our specialists offer surgical options to adjust the muscles around the eye to align vision in both eyes. Under local anesthesia with sedation for adults, one or more of the eye muscles are strengthened, weakened or moved to a different position to improve eye alignment. In some cases both eyes will require surgery even when only one eye appears to be misaligned. Strabismus surgery is a highly successful procedure and most patients see great improvement in eye alignment. In some cases for optimal vision, further adjustments may be required such as additional surgery or the use of prism glasses. Therapy may be prescribed after surgery to improve the surgical outcome.