Strabismus: A general term used to describe misaligned eye. Types of strabismus include  horizontal…esotropia (turned in or crossed eyes), exotropia (eyes turned out) and vertically called hypertropia       (eyes up or down from one another).

·         Esotropia: Crossed eyes may occur between birth and 6 months of age ( congenital or  infantile esotropia) or the crossing may occur after 6 months of age (acquired esotropia).

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o        Congenital or infantile esotropia may be treated with eye patching to prevent amblyopia, glasses if the child has a significant degree of far-sightedness / astigmatism, or eye muscle surgery. It is normal for a child to have intermittent episodes of crossing the first two months of life; however, if the child has either persistent crossing or continued intermittent crossing after 2 months of age; professional eye care should be sought as soon as possible. Ignoring the crossing may result in permanent loss of vision from the development of a amblyopic (child stops using or suppresses the crossed eye) eye.

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o        Acquired esotropia is treated with glasses or eye muscle surgery. Eye exercises have NOT been shown to be effective for the treatment of esotropia

o        Accommodative esotropia is the form of acquired crossing that responds favorably to spectacle correction. Generally these children are farsighted ( hyperopia) and they have an exaggerated crossing or convergence of their eyes when they try to focus their farsightedness. When placed in glasses, the glasses do the focusing for the child allowing their exaggerated focus and convergence response to relax; therefore resulting in straight eyes. Approximately 25% of these children outgrow the need for glasses by age 10. Contact lenses respond the same way as glasses in these patients. Surgery, in general, is contraindicated in children whose eyes straighten. with glasses. Occasionally, children that have more crossing at near compared to distance viewing require the need of bifocals to establish straight eyes

Non Accommodative Esotropia or esotropia that does not respond to straightening with spectacle correction will require surgical correction. Surgery involve a procedure that changes the position (recession) and sometimes strength of an eye muscle resection).

     Before surgery      after Surgery

• Exotropia may be seen the first 6 months of life (congenital exotropia) but is more commonly presents after 18 months of age. It frequently starts out as an intermittent problem seen mostly when the child is tired or sick. It can however present as a full time outward deviation of one or both eyes. These children are also seen to squint their eyes in the bright sunlight.
• Exotropia is treated generally when the eye is seen to deviate outward more than 50% of the time. Treatment options may include patching a dominant eye to prevent suppress of a deviated eye or amblyopia from disuse of the deviated eye. If the patient has any significant refractive error such as nearsightedness, farsightedness, or astigmatism glasses will be prescribed. In one form of exotropia at near viewing (convergence insufficiency) eye exercises may be beneficial. If patching or glasses are not indicated of effective then eye muscle surgery is preformed to align the eyes.

Hypertropia is  a relatively rare form of strabismus. Many times these children present with a head tilt. Children with hypertropia are treated with patching if decreased vision from disuse of an eye is suspected. Glasses may be prescribed if there is a refractive error. Surgery is a common approach to treat hypertropia,

Amblyopia (lazy eye) is a term used when the eye doctor suspects the vision is decreased in a child. Think of amblyopia as a result of the brain ignoring or not registering the visual stimulus sent from the eye. There are three types amblyopia, strabismic, refractive, and organic.

·         Strabismic amblyopia  occurs when an eye is not aligned. The brain initially perceives two images (double vision) and in children under age 8 it can quickly suppress or ignore the second image. This results in a disuse and eventual loss of vision on the involved side.  Patching the non-misaligned or dominate eye is prescribed to stimulate visual development.

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·         Refractive amblyopia results when a child is born with unequal refractive powers between the eyes. In other words, if one eye is more nearsighted or farsighted or has more astigmatism than the other, the brain will pick the clearest image or eye to see out of. Glasses or contacts are needed to treat this disorder along with patching the dominate better seeing eye.

·         Organic amblyopia results in patients that have a disorder of their eye such as a cataract that prevents them from obtaining a clear image being sent to the brain. The treatment of organic amblyopia requires the treatment of the medical eye disorder and then patching the dominant or better seeing eye.
 

·         The earlier in a child’s visual development the diagnosis of amblyopia is made the easier the treatment and the better the prognosis. THIS IS WHY IT IS SO IMPORTANT TO DETECT EYE PROBLEMS AT A YOUNG AGE…TO PREVENT PERMANENT VISUAL LOSS !