Strabismus (Strabismus)

Strabismus: Causes, Symptoms and OP Treatment of Strabismus in Children and Adults

If one speaks colloquially of squinting eyes, one speaks medically correctly of strabismus. Strabismus is a misalignment of the eyes caused by a disturbance of the balance in the eye muscle. Strabismus can be of varying severity, which means that possible restrictions in everyday life and the need for an operation as therapy vary. Strabismus can occur both generally and constantly and can also be clearly visible to other people, as well as only occur suddenly in certain situations. For example, when a certain angle of vision is adopted.

Not every form of strabismus needs treatment, because strabismus is not always due to illness. However, many affected persons, especially parents of strabismus children, want a therapy for cosmetic reasons or for psychological relief. On the other hand, pronounced strabismus is a serious eye disease that can lead to restrictions in life.

Strabismus is usually genetically inherited and can be diagnosed and treated in early childhood. In addition, strabismus can also occur suddenly in adults of advanced age, for example after a stroke. Whether a strabismus can be completely cured depends on the severity of the disease and the age of the patient. In the meantime, numerous modern therapies and surgical methods are available that enable safe treatment of children and adults.

Important: The treatment of strabismus is one of the specialties of ophthalmology and should therefore be carried out by a specialist with a lot of experience. In the case of eye operations, the costs should not be in the foreground if the cosmetic correction is not covered by health insurance.

Causes of strabismus – identification often difficult

In medicine, various forms of strabismus are known. Accordingly, different causes are known, depending on the severity. Basically, the different forms of strabismus are caused by changes in the optic nerves and parts of the eye area. What exactly causes these changes often cannot be answered exactly in individual cases. Since strabismus as a clinical picture has been well researched and numerous surgical methods are available, intensive causal research is not absolutely necessary.

Different forms of squinting in detail

In practice, numerous forms of strabismus are known. These include, for example:

  • Latent strabismus (heterophoria): Latent strabismus is a disturbance of the balance in the eye muscle, which can often be compensated by the affected person and therefore remains without discomfort. The disease is often not diagnosed because symptoms only occur at a certain intensity. Latent strabismus can be congenital, but can also be caused by external influences. Especially long working hours in front of monitors can promote the development.
  • Manifest strabismus (heterotropy): If there is a constant deviation of one eye from the normal viewing direction, this is a heterotropy. A distinction is also made between internal strabismus, external strabismus, vertical strabismus and rolling strabismus. A combination of these characteristics is also possible. In contrast to latent strabismus, manifest strabismus also manifests itself through visibility, which is perceived as unpleasant by many people affected. Depending on the severity of the disease, different therapy options can be considered, which on the one hand are aimed at maintaining vision and reducing visibility.
  • Paraplegic strabismus: Typical for paraplegic strabismus is that the affected eye is basically restricted in its ability to move and the strabismus does not only occur selectively. The severity of the strabismus depends on the underlying nerve damage and ranges from slight symptoms of failure to complete paralysis.
  • Mechanical strabismus: Another common type of strabismus in children and later in adulthood is mechanical strabismus. For example, certain diseases can lead to strabismus. Benign changes in the muscle and connective tissue mass can also be mentioned here.
  • Pseudostrabism: A strabismus is also known, which is superficially visible, but does not represent a disease in the medical sense, since no restrictions are connected with it. Patients or parents of affected children often wish to have corrective surgery on their eyes for cosmetic reasons. A well-known personality who suffered from pseudostrabism was Anette von Droste-Hülshoff.

Cross-eyed surgery on children? When to the doctor?

Due to the numerous manifestations of strabismus, there are also numerous therapeutic possibilities. Many therapies are aimed at a long-term and complete correction of squinting eyes and are therefore protracted. If a therapy is started in early childhood, it is usually completed in adolescence and strabismus is medically and cosmetically completely cured. In order for accompanying symptoms to be treated as successfully as possible, it is necessary to start therapy with children at an early age. If parents notice malpositions or abnormalities in their children, it is advisable to visit an ophthalmologist in good time.

The most frequent observations and reasons for a visit to the doctor are:

  • Child with one eye looking inwards
  • Child with one eye facing outwards
  • Child crossed with both eyes from time to time
  • Child squints when tired
  • Child squints during concentration or in certain situations

Many parents ask themselves: When to see an ophthalmologist? If your baby or child is squinting, the answer is simple: Immediately! Especially with babies (approx. 9 months) and toddlers between the ages of 2 and 4 years, squinting can be a warning sign for weak or defective vision. This should never be labelled as harmless and should always be examined by a doctor with experience with eye diseases in small children.

In the case of a slight squint (silver vision), correction with glasses is often advisable. This makes it possible to compensate for side effects such as ametropia at the same time. Another typical form of therapy is occlusion therapy. The affected eye is stimulated to fix itself either by a plaster, a blindfold or by a special foil on a visual aid. The frequency with which occlusion therapy is necessary is determined by the ophthalmologist, depending on the situation.

In addition, there are numerous other forms of medication or surgical treatment. For example, the healthy eye can be hindered with paralyzing eye drops, which stimulates the affected eye to correct itself. In particularly severe cases, surgery, popularly known as squint surgery, is also an option. It is often necessary to operate on the healthy eye as part of an operation. The costs of a strabismus operation for medical reasons should be discussed and approved with the health insurance before the operation.

For less severe forms, further therapy approaches with different chances of success are available. Only a specialist familiar with the patient can provide information about the chances of success. Typical procedures are orthoptics or pleoptics, which provide relief in certain cases. The costs usually have to be covered privately, as the health insurance only pays for medically necessary forms of treatment.

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Christina Cherry
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