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Top 5 Strabismus Treatment Options You Need To Know

Written by Andrew Le, MD

UpdatedFebruary 29, 2024

Strabismus, also known as crossed or lazy eye, is a condition that affects the alignment of the eyes. It is estimated that around 4% of the US population, or approximately 13 million people, are affected by this condition.

Studies have shown that people with strabismus may experience social anxiety, diminished self-esteem, and even depression. This is particularly true for children, who may face teasing or bullying from their peers due to their condition. However, adults with strabismus may also struggle with social situations and may feel self-conscious about their appearance.

Given the prevalence and impact of strabismus, finding effective treatment options is crucial. The good news is that effective treatment options, like medications, are available to address this concern.

In this article, we will explore the top 5 strabismus treatment choices that can make a significant difference. With the right treatment, people with strabismus can improve their vision, reduce their symptoms, and regain their confidence and quality of life.

🔑 Key Takeaways

  • Strabismus is a condition impacting the alignment of the eyes, wherein one eye gazes forward while the other may turn inward, outward, upward, or downward.
  • Strabismus can be divided into different types, including esotropias, exotropias, hypertropias and hypotropias, and paralytic strabismus.
  • Strabismus occurs due to irregularities in neuromuscular eye movement control involving the brain or the eye muscle, and several factors can contribute to it, such as genetics, nerve abnormalities, vision centers in the brain, and eye/orbit injury.
  • Children with strabismus may face teasing or bullying from their peers, while adults may struggle with social situations and feel self-conscious about their appearance.
  • Effective treatment options are available to address strabismus, and finding the right treatment can help people with strabismus improve their vision, reduce their symptoms, and regain their confidence and quality of life.
  • The top 5 strabismus treatment options include patching, corrective lenses, prism glasses, botulinum toxin injections, and surgery.
  • When diagnosing strabismus, an eye doctor will examine the eyes thoroughly and perform tests to measure visual acuity, eye movement, and deviation.
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What Is Strabismus?

Strabismus is a visual condition marked by eye misalignment and a lack of coordination, causing one eye to gaze straight ahead while the other may turn inward, outward, upward, or downward.

Various forms of strabismus exist, broadly categorized into the following groups:

  • Esotropias: An esotropia is a convergent strabismus where one eye turns towards the nose. It occurs in approximately 1.2% of the population aged between 4 to 74 years.
  • Exotropias: Exotropia is a type of strabismus condition where the eyes are not properly aligned. Specifically, exotropia occurs when one eye turns outwards away from the other. According to research, exotropia is relatively rare and is seen in approximately 2.1% of the population.
  • Hypertropias and hypotropias: These terms refer to the vertical misalignment of the eyes where one eye is higher (hypertropia) or lower (hypotropia) than the other. Hypertropia was more common (91.7%) than hypotropia (8.3%).
  • Paralytic strabismus: Paralytic strabismus is a condition where cranial nerves suffer damage, leading to limited eye movements and strabismus. Its prevalence among 3,075 cases with binocular vision anomalies was 10%.

What Are The Causes Of Strabismus?

Strabismus occurs due to irregularities in neuromuscular eye movement control involving the brain or the eye muscle. The following factors have been recognized as possible causes of strabismus:

  • Abnormalities in Eye Muscles: Strabismus can be caused by abnormalities in the muscles of the eyes.
  • Nerve Abnormalities: Abnormalities in the nerves that control eye muscles can contribute to strabismus.
  • Vision Centers in the Brain: Problems in the brain's vision centers responsible for controlling binocular vision can result in strabismus.
  • Genetics: There is a genetic component, and children of parents with strabismus have a greater risk of developing the condition.
  • Congenital or Acquired: Strabismus may be present from birth (congenital) or develop during infancy, childhood, or later.
  • Eye/orbit Injury: Injuries to the eye or orbit can be a risk factor for strabismus.
  • Head Trauma: Trauma to the head can contribute to the development of strabismus.
  • Premature Birth or Low Birth Weight: Being born prematurely or with low birth weight is identified as a risk factor.
  • Uncorrected Farsightedness (Hyperopia): Farsightedness that is not corrected can be associated with strabismus.
  • Muscular Abnormalities: Abnormalities in the eye muscles can lead to misalignment.
  • Neurological Abnormalities: Issues with the neurological system may contribute to strabismus.
  • Cerebral Palsy: Conditions such as cerebral palsy are mentioned as potential risk factors.
  • Down Syndrome: Down syndrome is listed as another risk factor for strabismus.

What Are The Strabismus Symptoms?

Strabismus usually appears in infants and young children, often when your child is 3. According to the age- and gender-adjusted annual incidence rate of 54.1 cases per 100,000 people, approximately 1 in 25 adults are likely to develop Strabismus during their lifetime, with an increased risk as they age.

Some common symptoms of strabismus include:

  • Double vision
  • Tilting or turning your head
  • Headaches
  • Difficulty reading
  • Eye strain
  • Closing one eye when looking at objects that are far away or when you're in bright light.

How Is Strabismus Diagnosed?

When diagnosing strabismus, an eye doctor will examine your eyes thoroughly. This typically involves a series of tests designed to measure your visual acuity, eye movement, and deviation, among other things.

The doctor will run some tests, which might include:

  • Corneal Light Reflex Test: Checks for crossed eyes.
  • Visual Acuity Test: Assesses your ability to read from a distance.
  • Cover/Uncover Test: Measures eye movement and deviation.
  • Retina Exam: Examines the backs of your eyes.

What Are The Treatments For Strabismus?

Strabismus, If left untreated, can even result in amblyopia (lazy eye). However, there are several treatments available to correct this condition. Here are five strabismus treatments that you should be aware of:

1. Glasses

Wearing eyeglasses is a non-invasive and effective method to manage strabismus, especially when identified and addressed early. One of the primary ways glasses help with eye alignment is by correcting refractive errors.

Refractive errors happen when the eye's shape hinders light from directly focusing on the retina, leading to blurred or distorted vision. By prescribing lenses with specific optical powers, eyeglasses can redirect incoming light to properly focus on the retina, addressing refractive errors and improving overall visual acuity.

Additionally, eyeglasses can help manage strabismus by incorporating prismatic lenses. These special lenses alter how light enters the eyes, helping to adjust the visual input and encourage proper eye alignment.

Prism glasses can be customized to shift the image one eye perceives, aligning it with the other eye to promote binocular vision. The American Optometric Association recognizes eyeglasses as a treatment option, especially when strabismus is detected and treated early. This is because eyeglasses can correct refractive errors and improve eye alignment.

2. Patching

Patching is a commonly used treatment for strabismus, a condition where the eyes are misaligned. This involves using a patch to cover the stronger eye, stimulating the weaker eye, and enhancing its vision.

Around 62% of patients patched for two hours daily showed improved visual acuity within four months of treatment. This technique is often used in children with amblyopia (lazy eye) to encourage the development of the weaker eye and enhance alignment.

According to Texas Children's Hospital, patching is suggested to align the eyes as much as possible and improve vision. The goal is to encourage both eyes to work together, promoting better alignment. The patching technique helps train the brain to pay attention to both eyes.

Sometimes, a child must wear an eye patch over the normally functioning eye. By covering the stronger eye, the weaker and misaligned eye is forced to work more, which can improve strength and vision in that eye. This helps in addressing the muscle imbalance associated with strabismus.

Early intervention through patching aims to enhance the child's depth perception. By encouraging the use of both eyes simultaneously, there is a greater chance for the child to develop good depth perception, good vision, and straight eyes.

3. Eye exercises

Eye exercises represent a treatment option for strabismus, designed to train the brain and eyes to collaborate better, enhancing eye coordination and focus. Some of the eye exercises that can help to treat strabismus include:

  • Pencil pushups: This exercise trains the eyes to move toward one another and simultaneously converge or focus on the same near object. It involves holding out a pencil at arm’s length in front of the eyes and moving it towards the face, about 2–3 centimeters from the brow, just above the nose.
  • Brock string: This exercise is used to improve convergence and suppression. It involves holding either end of a 10- to 15-foot white string containing several colored beads in either hand, holding one end near the nose, stretching the string out in front, and looking at the closest bead. The aim is to improve binocular vision, eye teaming, and eye coordination at all distances.
  • Barrel cards: This exercise aims to train convergence and reduce suppression. It involves using cards with three red and green targets opposite each other. The aim is to focus on the largest barrel until the two colors merge and the other two double.

4. Medication

Pharmacological interventions may be used to address specific conditions associated with strabismus, such as:

  • Paralytic Agents (Botulinum Toxin): Botulinum toxin, typically used in minute quantities, can be injected directly into the extraocular muscles to achieve controlled paralysis. It is more established in adults with paralytic strabismus but may be considered for comitant childhood strabismus, particularly with smaller degrees of misalignment and in patients with good binocular fusion.
  • Autonomic Agents (Atropine, Miotics): Atropine blurs vision in the non-amblyopic eye, an alternative to patching for older children. Miotics offer an alternative to bifocals in treating esotropia and residual esotropia post-surgery.
  • Centrally Acting Agents (Levodopa, Citicoline): Levodopa and citicoline are centrally acting agents that affect amblyopia's central visual system abnormalities. These neurotransmitter precursors have been demonstrated to improve vision in amblyopic eyes, although the therapeutic role of these agents in clinical management remains unproven.
  • Bupivacaine: A study conducted in Brazil mentioned using bupivacaine, a local anesthetic, to treat strabismus. It is injected into the muscles and makes them bigger and stiffer.

5. Surgery

Strabismus surgery is a medical procedure that aims to reposition the eye muscles to achieve proper eye alignment. This surgery is a viable option for most adult patients with strabismus, as it has a high success rate of 80-90%.

The procedure is effective in achieving satisfactory alignment with just one surgical intervention in the majority of cases. Strabismus surgery is a safe and reliable treatment option for those experiencing eye misalignment.

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Strabismus treatment, such as surgery, prism glasses, and medications, will help manage strabismus effectively. Early detection and treatment of strabismus can significantly improve the quality of life for children and adults with this condition.

Working closely with an eye doctor is vital to determine the most fitting treatment plan based on the type and severity of strabismus. With the right treatment, people with strabismus can improve their vision, reduce their symptoms, and regain confidence.

FAQs On Strabismus Treatment

What is the difference between amblyopia vs. strabismus?

Amblyopia, commonly known as a lazy eye, is a condition related to visual acuity, where one eye has reduced vision despite using corrective lenses. On the other hand, strabismus involves misalignment of the eyes, making them point in different directions. While strabismus affects eye alignment, amblyopia is primarily a visual acuity issue.

Is it possible to correct strabismus naturally?

Yes. Correcting strabismus naturally in adults and children is possible by performing eye exercises. However, if these exercises do not work, your doctor may recommend surgery to adjust the muscles around the eye and align it correctly.

Is it possible for strabismus to resolve without treatment?

Strabismus does not go away on its own— but it is usually treatable. Strabismus is a treatable condition that requires proper diagnosis and treatment. With the right care, children can maintain healthy development and clear vision.

What are the consequences if strabismus is left uncorrected?

People born with strabismus may lose binocular vision or develop double vision without treatment.

Does insurance cover strabismus treatment?

Typically, insurance covers the expenses associated with strabismus treatment. However, it's crucial to verify your coverage with your insurance provider.