Published: Feb. 24, 2012
Updated: Feb. 24, 2012
Amblyopia, Strabismus, and Orthoptics (PDF): This brochure answers common questions about this specialized type of treatment
Strabismus is the medical term for misalignment of the eyes. In strabismus, the eyes can be not work together because the eyes are turning in (“crossed eyes” or esotropia), out (exotropia), up, or down abnormally.
Approximately four percent of children in the United States are affected by strabismus. Adults can also have strabismus causing double vision. Strabismus is common after thryoid-related eye disease (such as Graves ophthalmopathy and hypothyroidsm).
There are various reasons for this condition, ranging from a need for glasses to ocular (eye) or neurological abnormalities. A parent or close relative is often the ﬁrst to notice a vision problem.
When a vision problem is suspected, a complete eye examination should be arranged as soon as possible. Early detection and management are important for best results.
The Duke Pediatric Eye team includes pediatric ophthalmologists, orthoptists, and technicians. Orthoptists specialize in identifying eye muscle imbalances and examining children with eye problems. They assess visual acuity in infants and children, measure ocular deviations, and evaluate eye movements.
The level of the examination will be adapted to your child’s ability to respond. We obtain much useful information through observation of your child’s visual behavior.
Although responses are helpful, verbal ability is not necessary to complete an accurate eye examination.
When a young child uses one eye predominately and does not alternate between the two eyes, the prolonged suppression of the non-dominant eye by the brain may develop into amblyopia.
Amblyopia is sometimes referred to as “lazy eye,” but it is more than just an eye problem. The visual portion of the brain is suppressed and vision actually decreases in the unused eye.
There are different causes of amblyopia:
In some cases there may be more than one cause.
Amblyopia (“lazy eye”) is by far the greatest cause of treatable vision loss in the United States. A child with amblyopia may lose vision in the affected eye permanently if the situation is not corrected early. Treatment is more difﬁcult and less effective with children older than nine or 10 years of age.
If your child is diagnosed with amblyopia, an individual active treatment program will be designed. This program may involve one or more of the following: eyeglasses, patch therapy, eye drops that dilate the pupil, and, in some cases, a contact lens.
Your ophthalmologist and orthoptist will give you speciﬁc information about the treatment for your child.
Many patients with eye deviations will eventually need an operation to align the eyes. The goals of surgery are twofold. The ﬁrst is to change the present eye alignment in such a way as to enable the brain to use both eyes together. This may reestablish binocular function. The second is to improve the appearance so that the eyes look straight and move together.
The chances for achieving these goals are inﬂuenced by the size and complexity of the eye deviation, the age of onset, types of previous treatment, quality of binocular function (depth perception), and the compliance with pre- and postoperative therapy.
The results of strabismus surgery are not always perfect because human tissue varies from individual to individual. Therefore, it may take more than one operation to achieve the goal of straight eyes. The success rate varies from 50 to 90 percent, depending on the type of operation and condition of the eyes.
In some cases the surgery may be performed in steps, with the ﬁrst operation designed to correct only part of the problem. A second or even third operation may be necessary to deal with any residual misalignment or to correct another aspect of the problem. The purpose of this discussion is to acquaint you with the facts about strabismus surgery. With vigorous and complete treatment the results are usually extremely gratifying.
For strabismus, amblyopia (lazy eye), and related eye muscle disorder treatments, visit a Duke Eye Center near you in Durham, Raleigh, Cary, and other areas of North Carolina.