Strabismus (Crossed Eyes) Symptoms, Treatment
Eye doctors call crossed eyes turning toward the nose esotropia from two words of Greek origin: eso, meaning inward, and trope, which means to turn. This is a type of strabismus, another medical term referring to a misalignment in the visual system.
For normal vision, the eyes need to align correctly. Each eye sends visual information to the brain separately, which then puts the two pictures together to create vision.
There are six muscles in each eyeball responsible for correct eye movement. If there is a dysfunction in this muscular system, the eyes can go out of alignment. When this happens, the brain has trouble interpreting the information it gets from each eye. This can cause blurry or double vision.
Esotropia is more common in infants and young children. In fact, many babies are born cross-eyed, but this tends to clear on its own within the first three months of life. However, esotropia can happen to adults, too. It may also run in families.
Other Terms of Misalignment
The term strabismus refers to a problem with eye alignment. There are several types of it. Besides esotropia, there is exotropia. Exotropia means the eyes turn outward and is also known as being wall-eyed.
There is also hypertropia, where the eyes turn upwards, and its opposite hypotropia, which means the eyes turn downwards.
Each one requires different types of therapy and expert management by an eye care professional.
Types of Strabismus
There are several reasons why the eyes may become misaligned. Sometimes, it’s due to specific health issues, or the person may be trying to overcome a vision problem like being farsighted in only one eye.
Your eye doctor will evaluate your symptoms, how the eyes cross, your age, and even how your brain reacts to certain stimuli.
Eye doctors also treat infantile esotropia, which affects babies. These babies may have good vision, but if their strabismus isn’t corrected early, they could face problems in the future.
It’s not unusual for a child to be born with crossed eyes. The condition generally clears within three months of birth and needs no treatment.
Infantile esotropia only needs treatment if it persists beyond three months of age. At this point, it’s sometimes called congenital esotropia and requires medical attention.
A baby with congenital esotropia typically has normal vision in each eye. That is not the problem. The problem is with the misalignment of the eyes, causing confusing information to be sent to the brain. Under these circumstances, the brain cannot create a focused visual field.
In some cases, the brain ignores information from one eye in favor of the other. This can weaken the ignored eye and lead to a condition called amblyopia or lazy eye.
Eye doctors sometimes see a condition called pseudostrabismus. This occurs when a child’s nose and eyelid shape give the impression of strabismus when there is no actual eye-crossing at all.
Any child with possible pseudostrabismus still requires a comprehensive evaluation by an eye care professional to ensure there is nothing wrong.
Babies’ vision is poor at birth and improves considerably by the age of six months. This is the target point for strabismus treatment.
Constant, Alternating, and Intermittent Esotropia
Eyes may cross all the time, which is called constant esotropia. The alternating form switches from one eye to the other, while the intermittent type appears to come and go.
This occurs when the patient attempts to focus. For example, a child who is farsighted in one eye but has normal vision in the other may have crossed eyes when trying to get the two eyes to work together.
This type of self-adjustment of the eye angle can threaten the child’s further visual development. Eye doctors have many ways of correcting accommodative esotropia, and commonly, this is with eyeglasses. If this fails, the condition becomes non-accommodative esotropia.
Your eye doctor will ask you questions about family history during the exam because esotropia may have a genetic component. Other risk factors include down syndrome, strokes, cerebral palsy, and head injury.
You can expect a series of tests to determine the type of esotropia. For example, if the doctor covers one eye and the other eye turns inwards, this tends to confirm true esotropia.
Other eye tests reveal if the esotropia will accommodate correction for nearsightedness, farsightedness, and astigmatism. Your eye doctor will almost always start with the least invasive, effective treatment possible.
Most kids with accommodative esotropia respond well to therapy with eyeglasses. Your eye doctor will decide if single vision or bifocal lenses are best. The child will also receive training on wearing their glasses properly.
Eyeglasses help esotropia by encouraging the eyes to align correctly. You may need to remind your child to relax their eye muscles and allow their glasses to work like they’re supposed to. Children may need emotional support and gentle reassurance because eyeglasses can take a long time, even months, to work. Patience is key.
Adults with crossed eyes are another matter. They are more likely to have some underlying condition contributing to the problem and less likely to get satisfactory results with eyeglasses alone.
Eyeglasses or prisms might help some adults, but others may need more involved treatment, such as vision therapy or even surgery.
An eye patch might help some people with esotropia, mainly to help strengthen a lazy eye.
It may be possible to retrain the eye muscles back into alignment. Some eye doctors specialize in this. It’s best to consult with your eye care professional for any eye exercises and not rely on information from the internet.
Next in line is Botox, a purified preparation of botulinum toxin. It may be used to control muscles associated with strabismus. The last resort for the treatment of esotropia is surgery.
Surgery for Strabismus
Your eye doctor will probably avoid surgery for strabismus for a child if at all possible. However, if other methods to correct the problem have failed, some types of esotropia may be correctable by surgery.
Adults with strabismus caused by hyperthyroidism, diabetes, strokes, head injuries, or tumors may undergo surgery. Their underlying medical condition has caused their eye muscles to pull the eyeball out of alignment. The surgeon must adjust these muscles, so they work normally again.
Strabismus surgery isn’t that involved. It can be done on an outpatient basis and without much downtime.
When symptoms of possible strabismus occur, the best chance for recovery is immediate treatment. Young children and older infants with esotropia need constant monitoring to avoid permanent vision damage in the future.
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