Strabismus Correction

Strabismus is a condition in which one or both eyes are not aligned toward the same point. An eye may turn inward toward the nose, outward toward the temple, upward, or downward. Strabismus may be congenital or acquired, constant or intermittent.

The goal of treatment is not only to improve eye alignment. In children, it is especially important to preserve or develop visual acuity and coordinated use of both eyes. Depending on the type and cause of strabismus, treatment may include glasses, amblyopia therapy, specific eye exercises, or surgery.

What Is Strabismus?

Normally, both eyes are directed toward the same object at the same time, and the brain combines the images received from each eye into a single image. In strabismus, one eye, or sometimes both eyes, deviates from its normal position.

Strabismus is not simply a cosmetic change. It can interfere with binocular vision and depth perception and, in children, may also lead to amblyopia, commonly known as “lazy eye,” in which vision in the misaligned eye does not develop normally.

In everyday language, different expressions may sometimes be used to describe the condition, but the correct medical term is strabismus.

Types of Strabismus

Strabismus is classified according to the direction of eye deviation, the time of onset, and the underlying cause.

In esotropia, the eye turns inward toward the nose. It is common in childhood and, in some cases, is associated with farsightedness.

In exotropia, the eye turns outward toward the temple. It may be constant or intermittent and can become more noticeable when the person is tired, looking into the distance, or less focused.

In vertical strabismus, the eye deviates upward or downward.

Childhood strabismus may be congenital or develop during the first years of life. Early treatment is especially important because the visual system is still developing during this period.

Acquired strabismus can develop at any age. In adults, sudden-onset strabismus is often accompanied by double vision and requires evaluation to determine the underlying cause.

Strabismus may also be paralytic, meaning that eye movement is restricted because of dysfunction of one of the extraocular muscles or the nerve that controls it.

When Is Strabismus Correction Needed?

An ophthalmologic evaluation is particularly important if:

• the eye deviation is constant or occurs frequently;
• a child repeatedly closes one eye or holds the head in an unusual position;
• there is a difference in vision between the two eyes;
• amblyopia has developed;
• double vision is present;
• strabismus appears suddenly;
• glasses or other non-surgical treatment have not provided sufficient improvement.

Sudden-onset strabismus in an adult should be evaluated as soon as possible, especially if it is accompanied by double vision, drooping of the eyelid, headache, or other neurological symptoms.

Treatment of Strabismus

Strabismus treatment depends on the type and cause of the condition, the patient’s age, visual acuity, and the ability of both eyes to work together.

Treatment may be non-surgical or surgical.

Non-Surgical Treatment

Strabismus surgery is not necessary in every case from the outset. Treatment may begin with correction of refractive errors and other visual problems.

Glasses. If strabismus is associated with farsightedness, nearsightedness, or astigmatism, correctly prescribed glasses may reduce the eye deviation. Glasses are particularly important in the treatment of certain forms of esotropia.

Amblyopia treatment. If vision in the misaligned eye is reduced, temporary patching of the better-seeing eye may be recommended. The aim is to encourage greater use of the weaker eye.

Orthoptic exercises. Specific exercises may be used for certain types of strabismus and disorders of binocular coordination. They are not effective for all forms of strabismus and cannot replace surgery when surgical adjustment of the eye muscles is required.

Prism glasses. In some patients, particularly those with double vision, prisms may help align the images and reduce symptoms.

Strabismus Treatment at Nairi Medical Center

Nairi Medical Center provides consultations with ophthalmologists and pediatric ophthalmologists, visual assessment, and the necessary instrumental examinations. Surgical methods of strabismus correction are also available at the center.

The treatment plan is developed after a complete examination and takes into account the type of strabismus, the degree of eye deviation, refractive status, the presence of amblyopia, and binocular vision.

Strabismus Surgery

During strabismus surgery, the surgeon operates on the external muscles that control eye movement. The eyeball is not removed, and the procedure is not performed inside the eye.

The main surgical approaches include:

Muscle weakening (recession). A muscle that is pulling too strongly is repositioned farther back to reduce its pulling force.

Muscle strengthening (resection or plication). The muscle is shortened or reinforced to increase its effect.

A single operation may involve one or several muscles and, in some cases, both eyes.

The aim of surgery is to align the eyes as closely as possible. In some cases, one procedure may not be sufficient, and additional correction may be needed later.

Preparing for Strabismus Surgery

A detailed ophthalmologic examination is performed before surgery.

This usually includes assessment of:

• visual acuity in both eyes;
• refraction, including nearsightedness, farsightedness, or astigmatism;
• eye movements;
• the direction and degree of deviation in different gaze positions;
• binocular vision;
• the presence of amblyopia.

If glasses are needed, appropriate optical correction may first be prescribed, and the need for surgery may then be reassessed.

A standard preoperative medical and anesthesia assessment is also performed before surgery.

Contraindications to Strabismus Surgery

Elective surgery may be postponed in the presence of an active eye or systemic infection, acute ocular inflammation, an uncontrolled general medical condition, or a temporary contraindication to anesthesia.

In addition, if the cause of strabismus has not yet been established, particularly in adults with sudden-onset strabismus, the underlying cause should first be investigated.

Recovery After Strabismus Surgery

Most patients are discharged from the hospital on the same day after surgery. During the first few days, redness, tearing, a gritty or foreign-body sensation, and mild pain may occur.

Temporary double vision may also occur and often improves gradually.

During recovery, it is important to:

• avoid rubbing the operated eye;
• use the prescribed eye drops;
• protect the eye from contaminated water;
• avoid dusty and sandy environments during the first few weeks;
• avoid swimming pools for approximately 4 weeks;
• return to intensive sports only after adequate recovery.

In many cases, patients can return to school or work after about one week, while full recovery may take several weeks.

Strabismus Correction at Nairi Medical Center

Strabismus correction is available through the Ophthalmology Service at Nairi Medical Center. Patients can receive consultations with an ophthalmologist or pediatric ophthalmologist, undergo visual assessment, and complete the necessary examinations.

This is particularly important in childhood strabismus, where the treatment plan must take into account not only eye alignment but also visual development and the possible presence of amblyopia.

If you would like to learn the cost of strabismus surgery or schedule an appointment, please call 89 00 or visit Nairi Medical Center at 21 Paronyan Street.