Eye Muscle Problems

Adult and Pediatric Strabismus

Strabismus (crossed eyes or wandering eyes) refers to eyes that are out of alignment. The eyes may be converged (crossed), diverged (outwardly deviated), vertically misaligned (one eye higher than the other), or torsionally misaligned (one or both eyes rotated inwardly or outwardly).

There are four types of severe misalignment:

  • Esotropia: Crossing or deviation of one or both eyes toward the nose
  • Exotropia: Outward (toward the ear) deviation of one or both eyes
  • Hypertropia (high) or Hypotropia (low): Vertical deviation or divergence of the eyes
  • Cyclotropia: Torsional (rotational or tilting) misalignment

What are the Causes of Strabismus?

Eyes are controlled by muscles, which are in turn controlled by the brain. For the eyes to be appropriately aligned and to focus straight on a single object, the muscles must be balanced and work together at the same strength level. Misalignment occurs when one or more of the muscles are weaker than the others. Eye misalignment, or strabismus, can be associated with medical conditions affecting the brain, such as cerebral palsy, Down syndrome, and hydrocephalus. Vision loss caused by eye injuries, cataracts, or stroke may also result in strabismus. However, most children with strabismus do not have an associated medical condition. Strabismus has a genetic component and can affect multiple members of the same family.

Signs and Symptoms of Strabismus

The most obvious sign of misaligned eyes is when the eyes appear to be pointed in different directions. However, the following signs may be indicative of strabismus:

  • Eyes that do not move together
  • Unsymmetrical points of light reflection in each eye
  • Tilting the head to one side
  • Inability to gauge depth
  • Squinting with only one eye

Strabismus Treatment Options

Strabismus treatment options range from observation – through optical, prismatic, certain medical, and occasional exercise therapies – to eye surgery. In order to improve vision, the weakened muscles in the affected eye or eyes must be put to work. Several treatments may be used alone or in combination, depending on the type, severity, and cause of strabismus, including:

  • Eyeglasses or contact lenses: This method may help people who have crossed eyes due to an uncorrected farsightedness.
  • Medicated eye drops: In some cases, as an alternative to patching, eye drops are used in the stronger (good) eye to temporarily blur the vision in the good eye. This forces the use of the weaker eye.
  • Strabismus eye surgery: Straightens and realigns muscles in the eyes. This method has a high success rate, although it involves more risk than other options.
  • Patching or covering the better-seeing eye: Like eye drops, this method works to strengthen the weakened eye.

Strabismus Surgery Procedure

Strabismus surgery is an outpatient surgery done under general anesthesia.

There are two common methods to alter extraocular muscles.

  • Recession: In a recession, the eye muscle is weakened. The doctor makes an incision in the conjunctiva (the clear membrane covering the sclera), puts a suture into the muscle to stabilize it, and moves the muscle to a more posterior position on the sclera (white part of the eye). The muscle is sewn to the sclera to anchor it to the eye. This weakens the muscle.
  • Resection: In a resection, the muscle is strengthened. The muscle is detached from the sclera, and a piece of muscle is removed so the muscle is shorter. The muscle is then reattached to the sclera. This strengthens the muscle.

At the Marietta Eye Clinic, we are proud to bring you the experience of fellowship-trained strabismus specialists who can diagnose and treat a multitude of eye misalignment disorders. If you have been told that you might need eye muscle surgery, research this process thoroughly and examine your options. For more detailed information regarding this eye surgery procedure, how to choose your doctor, risks of surgery, and what to expect after surgery, contact us at (770) 427-8111 to speak to a strabismus specialist.

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