Strabismus – Crossed eyes

“Because our eyes cannot deceive us,” we must pay attention to eye problems, especially strabismus (crossed eyes), which requires treatment as it’s not a trivial matter. With the prevalence of smartphones among all ages, awareness is crucial. Research shows that using a smartphone for more than 4 hours a day for 3 to 4 consecutive months can lead to strabismus.

Understanding strabismus

Strabismus is a condition where the eyes do not align properly, resulting in misalignment. It can be categorized into three types:

1. Pseudostrabismus: This condition appears as if the eyes are crossed but is not due to any actual abnormality. It might look like strabismus due to excess skin around the inner corner of the eyes or a flat nose bridge, especially in young children. Premature infants may also have abnormal eye structures that create the appearance of crossed eyes.
2. Latent strabismus: This type requires careful examination, usually through photographs taken with flash to observe light reflection, or by alternating eye patching.
3. True strabismus: This is clearly noticeable as the light reflection does not fall centrally on the pupil, and moving the patch from one eye to the other will reveal noticeable movement of the pupils.

Causes of true strabismus

True strabismus can arise from three main abnormalities:

1. Muscle abnormalities: Issues in the eye muscles, such as weakness, improper positioning, or tissue issues.
2. Nerve abnormalities: Problems in the nerves that control eye muscles, particularly cranial nerves III, IV, and VI, which may be affected by inflammation or tumors.
3. Neurotransmitter issues: Conditions like Myasthenia Gravis (MG) or the dropping of eyelids during physical activity can cause double vision.

Additionally, acute strabismus can lead to double vision. To determine the cause, one eye can be covered. If the double vision disappears, it may indicate a muscle problem or strabismus; if it persists, it could be due to astigmatism.

Observing for strabismus

To check for strabismus, you can do the following:

• Take a frontal photo with flash and observe the light reflection on the pupil. If it falls in the center, vision is likely normal. If not, there may be an issue.
• Alternate covering each eye while focusing on an object about a foot away. In normal vision, the eyes should remain still. If there is movement, it could indicate strabismus, warranting a visit to an eye doctor for further examination.

Treating strabismus

If you notice any abnormalities or have concerns about vision, see an ophthalmologist promptly for assessment and treatment, which may include:

• Non-surgical treatments: Use of glasses, patching the stronger eye to address lazy eye, and eye muscle exercises.
• Surgical treatments: This option is typically considered if non-surgical methods do not yield results.

Development of binocular vision, depth perception, and 3D vision naturally occurs before age 2. If treatment is delayed beyond this age, while it may correct alignment, 3D vision may not fully return. Therefore, it is crucial to address strabismus promptly to avoid missed opportunities for effective treatment.