Strabismus/Esotropia/Exotropia

Strabismus

A more severe eye teaming problem can result in the misalignment of the eyes and create difficulty with depth perception and judging how far away something is. Sometimes this is caused by a severe misalignment of the eyes that can easily be observed by a layperson or in photographs and sometimes it is more subtle and can only be detected by a trained observer. Over time, these severe eye teaming problems can cause double vision or sometimes other undesirable adaptations such as head turns/tilts, suppression of visual information from the turned eye, or amblyopia/lazy eye. Sometimes when suppression is present, there are fewer symptoms, but not always. While these adaptations reduce the confusion, poor eye alignment interferes with the ability to judge distances for driving and in sports. It creates difficulty with eye-hand coordination and creates an overall inefficient visual system. In some cases, it results in symptoms similar to a convergence disorder.

Types of Strabismus

Esotropia

Esotropia, often referred to as "crossed eyes" or "lazy eye," is a type of strabismus, a condition where the eyes do not align properly. In esotropia, one eye turns inward while the other remains straight, making it challenging for both eyes to focus on the same object at the same time.

Exotropia

Exotropia is a form of strabismus where one or both eyes turn outward, away from the nose. This condition can be constant or occur intermittently and can affect one or both eyes.

Types Of Exotropia

• Intermittent Exotropia: The eye turns outward occasionally, often when a person is tired, daydreaming, or looking at distant objects.
• Constant Exotropia: The outward turning of the eye is always present.
• Divergence Excess Type: Exotropia is worse at distance vs near
• Convergence Insufficiency Type: Exotropia is worse at near vs distance.
• Acquired Exotropia: Develops later in life due to factors like injury, illness, or neurological conditions. This condition is common in patients with a concussion.

What Is A Vertical Strabismus

Vertical strabismus, also known as hypertropia or vertical misalignment of the eyes, can have various causes and presentations. Vertical Strabismus typically creates double vision where one image is higher than the other.

Diagnosis and Treatment

If you suspect you or your child has strabismus, it's essential to consult an eye care specialist for a comprehensive eye examination. Treatment options may include:

• Eyeglasses or Contact Lenses: Correcting refractive errors can sometimes alleviate esotropia, especially in children.
• Reduce Visual Stress on the Eyes: Strabismus can often be made worse by prolonged periods of up-close work (computers, tablets, and phones) without taking breaks to look far into the distance. It is important to balance these activities with outside time and time away from computers/small screens. Wearing the proper glasses during these activities can also help.
• Vision Therapy: A specialized form of therapy to improve eye coordination. We work with patients of all ages to teach the patient how to coordinate the eyes and work together; as well as, obtain depth perception.
• Surgery: If other treatments are not effective, surgery may be recommended to correct the alignment of the eye muscles. There are risks with this treatment and sometimes multiple surgeries are required. In some cases, surgery may only improve cosmetic alignment without improving depth perception or other functional improvements.
• Prism: Prism redirects light and can be helpful in reducing double vision but needs to be used cautiously as often the amount of prism needed over time increases and can actually increase the likelihood of the eye turning more. This is called "prism adaptation".