[건강톡톡] How to treat ‘strabismus’ where the eyes are opened or crowded?

Strabismus is a vision disorder where the two eyes are not aligned and look at different places. If the two pupils are not aligned and the head tilts or turns constantly, strabismus may be suspected. From strabismus causes to treatment methods, we explored with an ophthalmologist in Hidak.

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Q. I’m curious about the symptoms that might suggest strabismus.
Strabismus that occurs in childhood can be difficult to detect because there are few or no subjective symptoms. If you cannot focus after 4 months of age and your eyes move differently, you should see an ophthalmologist.

In particular, in the case of ‘infantile esotropia’, where the eyes move inward in infants, delayed treatment can cause severe amblyopia, so surgical treatment should be carried out before the age of 2 years. Therefore, early diagnosis is important.

In children, strabismus can be suspected when symptoms such as eyes moving to one side or out when tired, closing one eye when looking at sunlight, or tilting the head to one side.

Strabismus that occurs in adults is often accompanied by double vision, so they often visit a hospital with symptoms of seeing two objects.
– Ophthalmology Consultant Hidak Hyungyo Jeong (Gangnam Brand Ophthalmology)

Q. Why does strabismus occur?

When one eye is aligned in one direction and one eye opens outwards, it is called ‘exotropia’, and when it is centered towards the inside of the nose, it is called ‘esotropia’. In adults, strabismus occurs when several muscles that move the eyes need to move equally, but one of those muscles malfunctions or doesn’t work properly.

Various causes such as problems with blood vessels, problems with viruses, trauma, etc. can affect different muscles that move the eyes. In particular, in recent years, the symptoms of acute esotropia due to the increase in the use of smart phones often appear among young people. If the eyeballs are not moved for a long time due to using a smartphone, symptoms of esotropia may occur due to the symptoms of the eyes gathering inward. This usually gets better again when you reduce your smartphone use.
– Hidak Ophthalmology Consultant, Director Gu Oh-seop (Glory Seoul Ophthalmology)

Q. Is strabismus that the pupil moves slightly inward when one eye is closed and then opens?
When you close your eyes and then open them, your eyes move in or out, up or down, etc. When the eyes are closed, the eyes are moved to a comfortable position, and when the eyes are closed, the movement is seen aligning them to their original position. Strabismus refers to the condition where the eyes are out of position even when the eyes are not covered.
– Ophthalmology Consultant Hidak Hyungyo Jeong (Gangnam Brand Ophthalmology)

Q. How is strabismus diagnosed?
Strabismus is a condition where the eyes are not aligned, and a clinical diagnosis is made. Clinical diagnosis simply means that the doctor sees and diagnoses himself. In the treatment room, the patient’s eyes are covered and opened and the diagnosis can be made by occlusion tests, occlusion and blindness tests, and alternating occlusion tests. To judge the degree of strabismus, the strabismus angle is measured using a prism.

When there is strabismus, △sight △refractive power △ range of eye movement △absence of diplopia △the presence of sensory abnormalities such as suppression or abnormal retinal response △stereoscopic vision function is very important in determining treatment and treatment method. That’s why we check them together in several ways.
– Ophthalmology Consultant Hidak Hyungyo Jeong (Gangnam Brand Ophthalmology)

Q. How is strabismus treated?
Treatment for strabismus depends on the cause of the strabismus. If strabismus is due to a refractive error in the eye, you may need to wear glasses, and if strabismus is caused by a cranial nerve abnormality, you may need treatment with a neurologist in the area. If there is an abnormality in the muscle that moves the eyeball, it may be difficult to treat with methods other than surgical treatment that aligns the two eyes by shortening or repositioning the muscle.
– Hidak Ophthalmology Consultant, Director Lee Seong-hoon (Gangnam Brand Ophthalmology)

Q. How is strabismus surgery performed?
Strabismus surgery is an operation that finds the cause of strabismus among the 6 muscles that correct the position of our eyes, cuts the conjunctiva, and pulls it back to its original position. In other words, it is a cut and stitch operation. Anesthesia is applied during the operation, so you do not feel any pain, but immediately after the operation, there may be a tingling sensation in the eyes or feeling of a foreign body to some extent. These symptoms tend to gradually subside over time.

On the day after strabismus surgery, the operated area is usually covered with a patch. It is recommended not to touch the surgical site and not to remove the patch for 1 to 2 days. In addition, water should not enter the surgical site for 2 weeks.
– Hidak Ophthalmology Consultant, Director Gu Oh-seop (Glory Seoul Ophthalmology)

Q. What will happen if I do not get timely treatment for strabismus?
As the main aim of treating strabismus in adults is to reduce discomfort, a comprehensive judgment is made based on the discomfort and the possibility of treatment success. In adults, even if strabismus is left untreated, it rarely causes visual impairment.

It is important to actively receive strabismus treatment for infants and children under 10 years of age. Stereoscopic vision and vision function are fully developed at a young age, and correct alignment of both eyes is essential for normal development.

If you have strabismus from an early age, your stereoscopic ability to distinguish between far and near objects and to see three-dimensional objects may not be sufficiently developed. Amblyopia can occur due to insufficient visual development. If the treatment time is missed, even if strabismus is treated late, the development of brain function has already been completed and appropriate visual ability may not be available. Therefore, early detection and treatment are very important diseases.
– Hidak Ophthalmology Consultant, Director Lee Seong-hoon (Gangnam Brand Ophthalmology)

* This article has been reproduced from Hidak’s expert answer.

Support = Consultant Hidak Hyungyo Jeong (Gangnam Brand Ophthalmology Specialist), Consultant Hidak Oh Seop Gu (Glory Seoul Eye Specialist), Consultant Hidak Seonghoon Lee (Gangnam Brand Ophthalmology Specialist)

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