The Clinical Approach to Strabismus

crosseyed person with motorcycle helmet

Strabismus is a medical term that refers to the misalignment of the eyes in newborns.

In the diagnosis procedure, distinct forms of eye misalignment are identified based on the orientation of the wandering eye. These are some examples:

  • Exotropia is an outwardly oriented eye.
  • Esotropia is an inwardly oriented eye.
  • Hypertropia is an upward-directed eye.
  • Hypotropia is a downward-directed eye.
  • Cyclotropia is the result of a mixture of several forms of eye direction.

Strabismus affects about 2-5 percent of the population. Under 4-6 months, any misalignment is not problematic in infants who are beginning to detect their surroundings.

If this misalignment persists beyond 6 months, parents should consult a doctor or an eye care practitioner.

Why Is Early Diagnosis Important?

Testing for and diagnosing strabismus often requires an eye exam tailored to identifying deviations in eye alignment and convergence.

Untreated strabismus in extreme situations can cause blindness, so it’s crucial to detect it early. For this reason, more infants and toddlers in industrialized nations have their eyes checked for any complications before they turn three.

Strabismus can be treated in three ways: 

  • surgery; 
  • glasses; 
  • a combination of the two.

Medical Background and Symptoms

Before beginning an eye examination, it is critical to gather a detailed history of the patient, including any relevant symptoms, environmental variables, medications, or health problems.

The following are some indications and symptoms of the condition:

  • crossed eyes
  • dual vision
  • reduced depth perception
  • uncoordinated motions 

Some medical problems, including Down syndrome, cerebral palsy, and Edwards syndrome, have been associated with strabismus, and people with these illnesses are more likely to have eye abnormalities.

cat with strabismus
Image by k from Pixabay

What Does An Eye Exam Look Like?

The eye exam usually comprises various tests used to evaluate the changes in vision caused by the condition and to guide treatment recommendations.

It can be performed without the use of eye drops; they can aid the assessment of the eyes under normal working circumstances, but they may be required for patients with impaired communication. Most often, a strabismus exam relies on findings made by a synoptophore

Some of the tests used in an eye examination to determine strabismus are:

A visual acuity test: is used to measure changes in vision and the clarity of vision at short and long distances. For example, reading letters on a chart over short and long distances.

Corneal light reflex test: used to measure the level of refractive error, which aids in determining the amount of lens power required to adjust for variations.

For example, a phoropter and a retinoscope are used to investigate how different glasses impact eyesight.

Alignment and focus test: to evaluate eye movement, focus, and unity.

Retinal exam: an examination of the physical anatomy of the eye to rule out the existence of other eye disorders that might be causing the symptoms.

Cover/uncover test: used to assess eye deviation and movement.

The findings of these tests can help you understand the presence and severity of the problem, as well as guide you through treatment options.

Making the Eye Examination Process Less Traumatizing

Children may find their initial visit to an eye clinic scary. They might be too young to grasp what is happening and may have to wait a long time to be examined. Making the initial appointment enjoyable for both the kid and the parents will make it less stressful.

The waiting room should be suitable for children. Play aides make a huge difference in the general atmosphere of the waiting room, easing some of the parents’ worry, which is reflected in the child’s behavior.

There are several strategies for obtaining the most information out of the initial visit:

  1. Observation: this may be done while speaking with the parents or while the kid is playing. Examine the visual behavior for an aberrant head position or evident strabismus.
  2. Lang stereo test: it could be turned into a game that is initially played by a sibling or a parent. It is an excellent first exam because it is not frightening and doesn’t require any intimidating eyewear. 
  3. Cartoon distance fixation: Children’s cartoons shown at the far end of the examination room are a helpful distance fixation target for cover testing and assessing fixation preference.
  4. Cycloplegic drops: 1 percent cyclopentolate instilled half an hour before refraction is sufficient for most kids. 

The best outcomes are produced when they are instilled by someone other than the eye care provider in a different room. 

If the child feels the instillation of drops at the clinic is upsetting, the parents can instill atropine drops or ointment at home before coming to the appointment.

  1. The optic nerve examination ought to include a magnified view. This can be accomplished with a direct ophthalmoscope or with slit-lamp biomicroscopy, which provides a considerably clearer image. 

It is critical to examine the fundus and disc appearance in children with refractive amblyopia to rule out other causes of impaired vision, like optic nerve hypoplasia.

  1. Hand-held slit-lamp: While an adult slit-lamp may be used to examine children, evaluating small children is much simpler using a hand-held slit-lamp.

A Little Discomfort Now Means Better Health Later

Most pediatric ophthalmologists devote a significant portion of their time to treating strabismus and amblyopia. Preparing kids for something that is uncomfortable may take up a large portion of parents’ patience. But if your child needs to see an ophthalmologist on a regular basis, there is a way to introduce them to the process.

Our VR Synoptophore is an interactive solution that can make the process more familiar to the younger ones. They will get comfortable with the sensation felt in their eyes before coming into the doctor’s office, therefore eliminating the factor of surprise they may feel at first. Its user interface is child-friendly, and “feeding the bunny” can even be fun for them.

As much as it is stressful for both the parents and the kid, it is extremely important to treat any early diagnosis of strabismus, as it will eliminate the possibility of any other underlying eye conditions in the future.