Strabismus is a condition in which the eyes are misaligned and cannot look at the same place at the same time: One eye may look straight ahead while the other eye turns inward (toward the nose) outward, (toward the ear), upward, or downward. The eye turn may be consistent or intermittent.
Strabismus affects about 4 percent of children in the United States; however, strabismus can also occur later in life. Many people with strabismus have no family history of the condition.
Accommodative esotropia is an inward turning of the eye(s) that occurs when children have more farsightedness than usual. Farsightedness is normal in children and does not affect their vision, because they have a special automatic focusing ability, like a “zoom” lens on a camera, that allows them to see clearly for reading and for seeing far away. Children with extra farsightedness can also focus to see clearly, but they must focus more and in doing so, their eyes often cross.
Infantile esotropia is a constant, inward turning of one of both eyes, usually detected by five months of age.
Infants whose eyes are not aligned in the first few months of life should be closely monitored by their primary-care doctors, as crossed eyes do not always require surgery. Any child older than five months whose eyes are not properly aligned should be examined by a pediatric ophthalmologist.
Intermittent exotropia is the outward turning of one or both eyes, which comes and goes. Intermittent exotropia is the most common type of strabismus.
Less commonly, the two eyes can be separated vertically (one eye higher than the other.) Misalignment of the eyes can also be associated with different ocular syndromes, such as Duane’s Syndrome and Brown’s syndrome.
Accommodative esotropia is correctable with glasses. Thomas Eye Group’s pediatric eye care specialists are proud to carry eyeglasses to treat children with accommodative esotropia. The lenses do the extra focusing for them, so they can see clearly and maintain straight eyes while the glasses are on. When they remove the glasses, their eyes will return to the misaligned (or crossed eye) position. The onset of accommodative esotropia can occur between the ages of one and five, with farsightedness increasing until the age of six or seven. When this happens, we increase the strength of the glasses to help keep the eyes straight. The farsightedness then typically decreases between ages eight and twelve, so we decrease the strength of glasses until they are not needed, around ten to twelve years old. Some children may continue to require correction throughout their lives and may need to wear contact lenses to control the crossing.
We usually treat infantile esotropia with eye muscle surgery. This is most common in children with persistent crossing of the eyes in the first two years of life, but can also include children whose crossing begins later in childhood but who do not require glasses. Our goal is to reposition the eyes as early as possible to encourage normal visual development.
Intermittent exotropia may come in a variety of presentations. As with any misalignment of the eyes, we always address any need for glasses as a first step. Small amounts of drifting or out-turning of the eyes may be easily controlled by the patient without causing any vision difficulties. In this case, no treatment is needed, or simple eye exercises may be performed to strengthen the patient’s control. Drifting that is more pronounced and occurs more frequently is most often treated with surgery, with the goal of improving eye alignment and allowing they eyes to work together as a team. While Exotropia can be treated at any age, our goal is to restore the proper position of the eyes at an early age so that no misalignment is apparent once the children are in elementary school.
Eye-muscle surgery to correct crossed eyes is performed on an outpatient basis at the hospital, most often under general anesthesia.
A small incision is made into the transparent covering of the eye (the conjunctiva) to reach the muscle. The muscle is then repositioned and reattached with tiny sutures that dissolve within one to two weeks. Most of our patients have surgery in the morning and then go home in the afternoon. The success rate of eye muscle surgery is 60-80 percent, so on average, 7 out of 10 people who undergo eye muscle surgery will achieve a good result with only one procedure.
The healing process is gradual and lasts about six weeks. Antibiotic eye drops will be prescribed for five to seven days after surgery. Discomfort following surgery is usually minimal, but the eyes will be quite red and may display a jelly-like swelling. This is normal and will clear over the next few weeks. Please note that the redness sometimes spreads before clearing. Some children may experience temporary double vision after the surgery as the brain gets used to the new position of the eyes. This is completely normal.
Children who have had eye surgery should avoid strenuous physical activity (PE, running or jumping, or heavy lifting) for ten days following the surgery. After the ten days, swimming is fine, but your child should wear goggles until the redness has subsided. Your child’s doctor will recheck the eyes a few days after surgery, then again one week later, and six weeks later.