Development of crossed eyes and inappropriate alignment of eyes in the same direction are the classical symptoms of strabismus. In addition to these, the eye disorder can also cause double vision, loss of vision, loss of perception of depth and difficulty in moving both the eyes together [6].

• Pain

  The bupivacaine group had significantly lower scores for pain after 30 minutes, total pain, and peak pain versus the lidocaine group. CONCLUSIONS: Sub-Tenon's bupivacaine may reduce postoperative pain in children undergoing strabismus surgery. [ncbi.nlm.nih.gov]

  Pain is minimal and usually over-the-counter medicines, such as ibuprofen (Motrin) or acetaminophen (Tylenol), and cool compresses are adequate. Adults and older children may need prescription pain medicine. [aao.org]

  Proparacaine did not impact outcome variables, except in patients younger than 3.5 years when post-op pain was worse. Conclusion: Post-op topical anesthetic either produced no difference, or worsened post-op pain and recovery. [dovepress.com]

  Pain The experience of pain seems to vary widely after strabismus surgery. The typical experience, especially for first-time operations, is moderate pain that responds to Tylenol or Motrin. [pediatricophthalmologypa.com]

• Inflammation

  No patient developed recurrence of inflammation or increased muscle restriction. [ncbi.nlm.nih.gov]

  They may occur suddenly if they result from an injury, inflammation or neurologic condition. Or they may appear to worsen or not improve if they have been present since birth. [childrensnational.org]

• Surgical Procedure

  Surgery to improve ocular alignment appears to herald major improvements in the quality of psychosocial functioning for the majority of adults undergoing such surgical procedures (P < 0.001). [ncbi.nlm.nih.gov]

  Fig. 1: Adult Strabismus, or misaligned eyes, can be surgically corrected. Is eye muscle surgery risky for adults? Every surgical procedure has some risks. [aapos.org]

• Swelling

  RESULTS: There were significant differences in conjunctival redness and swelling in both groups on postoperative days 1 and 7 and week 3. However, after the third week, both groups had a similar appearance. [ncbi.nlm.nih.gov]

  If significant post-operative swelling or discomfort occurs, you can reduce the swelling by applying ice packs to the operated area for 10 to 20 minutes every hour in the evening after you are discharged. [masseyeandear.org]

  The onset is acute, with redness, swelling, irritation, and watering of the eye and eyelids, along with a tender swelling of the lymph node in front of the ear. [britannica.com]

  This may be somewhat obscured by bruising and swelling. Alignment may, and likely will change as healing occurs. Therefore, no final conclusions about the effectiveness of the procedure can be rendered in the first few days after surgery. [pediatricophthalmologypa.com]

• Severe Pain

  Post-squint surgery, the patient developed pain and was being managed symptomatically. However, 1 week later, he developed diffuse corneal oedema and severe pain, and was readmitted for management in the same hospital. [ncbi.nlm.nih.gov]

  Indications for needle aspiration include severe pain and trismus, difficulty swallowing, and poor response to antimicrobials alone. [antimicrobe.org]

• Strabismus

  Strabismus can be constant or intermittent. The misalignment also might always affect the same eye (unilateral strabismus), or the two eyes may take turns being misaligned (alternating strabismus). [allaboutvision.com]

  KEYWORDS: Conjunctiva/Tenon’s capsule; retractor; strabismus [ncbi.nlm.nih.gov]

  […] physiology Alternative Titles: heterotropia, squint Strabismus, also called squint, misalignment of the eyes. [britannica.com]

  Nonparetic strabismus is generally concomitant.[36] Most types of infant and childhood strabismus are comitant.[37] Paretic strabismus can be either comitant or noncomitant. [en.wikipedia.org]

• Esotropia

  © 2001-2016 Esotropia (inward turning of the eyes) Congenital Esotropia Infantile Esotropia Esotropia with Amblyopia Accommodative Esotropia Partially Accommodative Esotropia Esotropia can be divided into various categories each requiring a different [strabismus.org]

  Esotropia (crossed eyes) needs to be treated early in life to prevent amblyopia. [allaboutvision.com]

  It may be more effective in many subtypes of esotropia where surgery has been less reliable, including partially accommodative esotropia, esotropia associated with cerebral palsy, and thyroid eye disease. [ncbi.nlm.nih.gov]

• Diplopia

  The goal of surgery was elimination of diplopia in primary and reading position. [ncbi.nlm.nih.gov]

  Treatment is directed at restoring and maintaining ocular alignment, eliminating diplopia or visual confusion, enabling binocular vision, and restoring normal appearance. [bestpractice.bmj.com]

• Visual Impairment

  Screening for visual impairment in children ages 1 to 5: recommendation statement. January 2011. [bestpractice.bmj.com]

  At this point, the visual impairment will be termed "amblyopia," which is reduced visual acuity in the turned eye. [familyconnect.org]

  In this dataset, for individuals with strabismus and a coexisting visual impairment, it has been the visual impairment that is recorded in the single field addressing vision. [onlinelibrary.wiley.com]

  The Brain and Cerebral Visual Impairment 57. Perceptual aspects of Cerebral Visual Impairment and their Management Section 5: Selected Topics in Pediatic Ophthalmology 58. Ethics, morality and consent in Pediatric Ophthalmology 59. [elsevier.com]

  ‘Visual impairment caused by refractive error, amblyopia, strabismus, and astigmatism is a common condition among young children, affecting 5 to 10 percent of all preschoolers.’ [oxforddictionaries.com]

• Lacrimation

  Lid and Orbital Capillary Hemangiomas and other Vascular Disease Part 3: Orbit and Lacrimal 21. Lacrimal System 22. Orbital Disease in Children 23. Neurogenic Tumours 24. Rhabdomyosarcoma 25. Other Mesenchymal Abnormalities 26. [elsevier.com]

  Inflammations of the lacrimal sac are much more common. [britannica.com]

  Oculoplastics and orbital surgery — Loyola’s surgeons have advanced training in reconstructive, ophthalmologic and cosmetic eye surgery for the eyelids, eyes, eyebrows, orbital cavity and lacrimal (tear duct) system, as well as the cheeks and forehead [loyolamedicine.org]

• Cerebellar Ataxia

  […] dysfunction, peripheral neuropathy, and progressive cerebellar ataxia. [frontiersin.org]

  Homepage Rare diseases Search Search for a rare disease Spinocerebellar ataxia type 40 Disease definition Spinocerebellar ataxia type 40 (SCA40) is a very rare subtype of autosomal dominant cerebellar ataxia type 1, characterized by the adult-onset of [orpha.net]

  SCA3 is a hereditary cerebellar ataxia that causes a degeneration of the cerebellum. There is damage created to the nerve cells and fibers that lead to the cerebellum’s damage. [lacaf.org]

  These 2 unusual cases exhibit a gradually progressive cerebellar ataxia syndrome plus features specifically associated with SCA2 (ie, slowed saccades) and SCA10 (ie, seizures). [jamanetwork.com]

  These patients presented with a form of cerebellar ataxia with slow saccadic eye movements4. [scielo.br]

• Irritability

  Although usually not serious in itself, it can give rise to considerable discomfort, irritation, and even impairment of vision. [britannica.com]

  There is surface irritation associated with the preparation and incision; and there is aching soreness, associated in particular with movement of the eyes. The former generally lasts up to 48 hours, and the latter typically up to one week. [pediatricophthalmologypa.com]

  Last but not least, its lower irritative effects on the airways are a reference point of general anesthesia induction in pediatric patients. [omicsonline.org]

At the preliminary level, a detailed physical examination of the eye will be carried out. This will be followed by various eye tests which would provide information about the extent of misalignment of the eyes. These tests include retinal exam, Hirschberg test, visual acuity, corneal light reflex and standard ophthalmic examination. In addition, neurological examination would also be performed to assess the neurological functioning [7].

Strabismus can be treated in several ways which include the following:

• Eye glasses or patch: Children with strabismus are prescribed eye glasses if required. Also, it is necessary to treat amblyopia at first and therefore a patch is recommended which covers the healthy eye and forces the child to see with the weak eye.
• Eye muscle surgery: When other treatment methods fail, eye surgery is usually the last resort. Through this surgery, the muscles of the eye will be made stronger or weaker depending on the condition. However, eye surgery would still require the child to wear glasses. It is also recommended that sooner the surgery is done better will be the outcome [8].
• Eye exercises are recommended for both children and adults with strabismus. This helps the eye muscles to strengthen and keep the eyes straight. 
• Botulinum toxin therapy was approved by the FDA way back in the year 1989 for treatment of strabismus in children over 12 years and adults. Children affected by infantile estropia benefit from this method. In this procedure, the toxin is injected in the stronger muscles in order to temporarily paralyze it [9] [10].

The prognosis of the condition post treatment is usually favorable. However, children and adults would continue to have vision problems. This may cause reading problems in children and adults would face difficulty while driving. Delay in treatment may lead to permanent vision loss in the weak eye. Follow up treatment and constant monitoring is a must as chances of recurrence of strabismus is high.

Strabismus is a common phenomenon both in children and adults. Failure of the eye muscles to work in coordination causes both the eyes to look in two different directions. Certain underlying disease conditions which can also lead to strabismus in children include cerebral palsy, Apert syndrome, retinoblastoma, congenital rubella, Noonan syndrome, Prader-Willi syndrome, traumatic brain injury, incontinentia iigmenti syndrome, trisomy 18 and development of hemangioma near the eye during infancy.

Various diseases associated with strabismus in adults consist of diabetes, botulism, stroke, eye injury, vision loss due to eye injury or disease, Guillain-Barré syndrome and shellfish poisoning. In addition to the above mentioned factors, heredity is also known to be a strong risk factor for development of strabismus [2].

It has been estimated that 4% of individuals in United States develop strabismus. Of the several forms of strabismus, estropia usually develops in the first decade of life [3]. It has also been reported that about 1/3rd of children with strabismus are at an increased risk of developing amblyopia.

Under normal conditions, the normal movement and alignment of human eye is governed by 6 muscles that work as a team. These ocular muscles help the eye to focus on the same object at same time. However, in instances when the muscles do not work appropriately it causes both the eye to look differently at two different objects.

As a result of this phenomenon, the brain receives information about 2 different objects. In children, the brain tends to ignore the information sent from the weak eye. In such situations, if strabismus is not promptly treated, then the brain will forever ignore information from the weak eye and as a result that eye will have poor vision. Such a condition is termed as amblyopia [4] [5].

So far there are no known methods of preventing strabismus. Its associated complications can however be prevented with early initiation of treatment.

When the eyes align inappropriately with each other, they are unable to focus together on the same point at the same time. Strabismus gravely affects the binocular vision and in turn affects the depth perception as well. A prompt treatment regime is required to correct the condition so that maximum vision acuity can be retained. Strabismus can be classified into 4 different types, depending on directional prefixes. These include estropia, exotropia, hypotropia and hypertropia [1].

Definition

Strabismus is an eye disorder characterized by inappropriate alignment of the eyes which does not allow both the eyes to focus at the same object at same time. An estimated 4% US population develops this eye disorder. Early initiation of treatment can help in preventing onset of complications.

Cause

A total of 6 eye muscles work in coordination to provide appropriate alignment to the eyes. When the muscles do not work as a team, then strabismus develops. In addition, certain underlying disease conditions such as diabetes, eye injury, stroke, eye disease, restinoblastoma, Noonan syndrome, Apert syndrome, congenital rubella, trisomy 18, cerebral palsy and Prader-Willi syndrome can also predispose children and adults to develop such a condition.

Symptoms

Crossed eyes and inappropriate eye alignment are the major symptoms experienced. In addition, individuals also experience poor vision, loss of vision, loss of depth perception and inability to move both eyes together.

Diagnosis

Diagnosis of strabismus begins with preliminary physical examination of the eyes. In addition, neurological examination is also carried out to assess the neurological functioning. Following this various eyes tests such as corneal light reflex, retinal exam, cover/uncover test, visual acuity and standard ophthalmic test are also performed.

Treatment

Treatment of strabismus includes prescribing eye glasses and patches to the children. In case, when these do not work then eye surgery is recommended. In addition to these methods, botulinum toxin injection is also employed for treating strabismus.

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4. Archer SM, Sondhi N, Helveston EM. Strabismus in infancy. Ophthalmology 1989; 96:133.
5. Mohney BG. Common forms of childhood esotropia. Ophthalmology. Apr 2001;108(4):805-9.
6. The eyes. In: Pediatric diagnosis: Interpretation of symptoms and signs in children and adolescents, 6th, Green M (Ed), WB Saunders Company, Philadelphia 1998. p.15.
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8. Ho TH, Lin MC, Sheu SJ. Surgical treatment of acquired esotropia in patients with high myopia. J Chin Med Assoc. Aug 2012;75(8):416-9.
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10. Fukai S, Arai N, Hayakawa T, Kimura H. Studies on the botulinum therapy for esotropia improvement of retinal correspondence. Nippon Ganka Gakkai Zasshi. Jun 1993;97(6):757-62.