A Case Of The Wandering Or Lazy Eye – Strabismus

When you were younger, maybe you used to turn both my eyes inwards and stick my tongue out when asked to make a funny face. Your parents may not have been as enthusiastic however. Have you ever heard “your eyes are going to stay stuck like that forever, you’re going to become cross-eyed!” But what is cross-eyed really and how does someone develop it?

Strabismus, sometimes called having crossed eyes, uncrossed eyes, or even lazy eye, is a vision condition in which the eyes are misaligned and point in different directions. Both eyes do not look at the same place at the same time. Patients with strabismus can have their eye positioned more upward, downward, inward or outward than normal. For example, the left eye could be looking straight ahead, but the right eye may be turned inwards. An inward crossing eye is more specifically known as esotropia. An outward turning eye is known as exotropia. An eye that deviates upwards compared to the fixating eye is known as hypertropia. Lastly, an eye that deviates downwards is known as hypotropia. Some patients have strabismus where this is misalignment is constant whereas others patients this may occur only intermittently.

So what causes strabismus? There are many factors that contribute to its development. Vision is a result of good partnership and coordination between our brain and eye muscles, so to have clear, single vision, both eyes must work and coordinate together. If you want to look at an object, your brain sends a command to your eye muscles and tell them to move your line of sight towards the object. After, each eye sends identical images back to your brain where it then combines the two images to produce a single, three-dimensional image. However, if something is off with either your eye muscles or your brain’s nerve/vision centers, issues that affect this process will arise. Genetics, injuries to the eye muscles or nerves, improper development of the brain where images combine, and problems with the brain’s command center are all factors that can lead to strabismus or a heterotropia.

Strabismus is a very serious condition and, if it goes untreated, can lead to amblyopia, which is when the brain stops relying on the strabismic eye, and only accepts and processes images sent from the more normal eye. Amblyopis is sometimes referred to having a lazy eye because the affected eye does not see as clearly and is thus less used. Since only one eye becomes more favored, your eyes stop working together and you lose binocular vision. This greatly reduces vision and the patient can also lose depth perception.

How do you know if you have strabismus and what are the symptoms? Some cases of strabismus are not as noticeable because the angle of deviation between the more normal eye and the strabismic eye is very small. This is known as small-angle strabismus but can lead to headaches and eyestrain because the brain is attempting to straighten the eyes out. A person may find reading uncomfortable because their vision is unstable and may even experience fatigue. On the other hand, some cases of strabismus are very noticeable. The misalignment of the eyes is obvious, and the angle between the person’s line of sight from the straight eye and that of the strabismic eye is large. This is known as a large-angle strabismus and typically, a person doesn’t experience headaches or eyestrain. Since there is such a deviation between the two eyes, the brain stops relying on the misaligned eye and makes no attempt to straighten the eyes out.

Strabismus doesn’t disappear overtime. The misalignment can get worse and a person can end up with amblyopia and extreme vision loss. This is why early detection and treatment is so important. There are multiple possible treatments a strabismic patient can take: glasses correction, vision therapy and extraocular muscle surgery as a last resort.  Strabismus surgery can effectively realign the eyes by altering the eyes anatomy. Its success depends on the direction and angle of the eye turn. With vision therapy, a patient works with a doctor and participates in a visual program to not only realign the eyes, but to retrain the brain to use and process both of the eyes. Even with strabismus surgery, those who had long-standing strabismus may still experience some amblyopia after surgery and recommend vision therapy afterwards. Some cases of strabismus, especially if mainly accommodative in nature as it relates to your eye focusing, can be simply fixed with the right pair of glasses and prism.

At Insight Vision Center Optometry in Costa Mesa, our optometrists Dr. Valerie Lam and Dr. Thanh Mai love working with patients with strabismus. If you feel that you or a loved one may have strabismus, please come in for an eye exam to determine if they do or not. One shoe certainly does not fit all, and your treatment program may involve a mixed combination of glasses, vision therapy, and surgery. Our vision therapy program will not only help in realigning your eyes, but to also help each eye into functioning as equally as possible, to train your brain into processing the strabismic eye and develop your peripheral awareness. Take action and see a doctor and discuss treatments. Insight Vision Center Optometry will be honored and more than happy to help you during these times. We want you to love the way you see!

Our optometry practice is located in Costa Mesa at 3151 Airway Ave. Suite J2, Costa Mesa, CA 92626.