Strabismus is the loss of the parallel alignment of our eyes. Each eye has three pairs of muscle groups arranged horizontally, vertically, and obliquely. Depending on which of these are affected, outward, inward, or oblique deviations may occur.
According to the age of onset, strabismus can be classified as congenital (present at birth),childhood strabismus, or adult-onset strabismus. It can also be grouped according to the direction of deviation: inward strabismus (esotropia),outward strabismus (exotropia),and vertical strabismus (hyper- or hypotropia).
Especially in infancy and childhood, strabismus must be treated not only for cosmetic correction but also due to its functional benefits. However, it should be kept in mind that in adult cases, treatment will mainly provide cosmetic improvement rather than functional recovery.
Strabismus that develops around the age of one (infantile strabismus) should be closely monitored and corrected surgically between the ages of 2–3. If not treated by around age 4, the child’s visual development, particularly depth perception and three-dimensional vision, will be permanently impaired.
Strabismus in early childhood often develops due to undetected refractive errors. For this reason, detailed eye examinations are crucial, and proper correction with glasses or other treatments must be provided to ensure clear vision. If sharp vision is not achieved and one eye continues to deviate, amblyopia (lazy eye) may occur. Unfortunately, after the age of 6–7, amblyopia is almost impossible to treat.
Strabismus that persists into school age and adolescence should also be corrected quickly—not only for visual reasons but also to prevent psychological and social difficulties.
Conclusion
Strabismus is a condition that not only impairs vision but also, unfortunately, causes significant social and psychological challenges, which are frequently observed in our society.
Especially in infants and children, distraction and restlessness are common, which makes computerized measuring devices—designed for younger age groups and yielding highly reliable results today—an essential part of the clinical examination.
In infants, strabismus examination can sometimes be vitally important. This is because when one eye begins to deviate in infancy, it may be due to a range of congenital diseases, and in some cases, even an early diagnosis of an eye tumor (retinoblastoma) can be made.
A strabismus examination must go beyond a standard eye exam and be more detailed. The younger the patient, the more fatigue and distraction may negatively affect the measurements. For this reason, patience and precision are required, particularly in children. In surgical candidates, since the degree of deviation can vary from day to day, taking measurements on 2–3 different occasions improves the success of treatment planning.
Cycloplegic refraction (examination with dilating eye drops) should be performed to detect refractive errors, and the retina should be evaluated. Glasses should be prescribed as a first step for all patients who need them. However, glasses alone are often not sufficient. In children, occlusion therapy (patching the non-deviating eye for several hours a day) is frequently added to force the deviating eye to focus on the target.
Strabismus treatment can be divided into non-surgical and surgical approaches.
Non-surgical treatments include glasses, prism therapy, occlusion therapy, and botulinum toxin injections. Botulinum toxin can sometimes be a suitable option to reduce or even eliminate the need for future surgery.
Surgical treatment is necessary when parallel alignment of the eyes cannot be achieved despite other therapies. Surgery allows the eyes to work in parallel and in coordination, enabling them to focus on the target simultaneously, thus achieving successful outcomes.
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