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Detection and Diagnosis

Children should be examined by the family doctor, pediatrician, or ophthalmol­ogist during infancy and preschool years to detect potential eye problems. This is particularly important if a relative has had strabismus or amblyopia.

In infants it is often difficult to deter­mine the difference between eyes that ap­pear to be crossed and true strabismus. Young children often have a wide, flat nose and a fold of skin at the inner eyelid that tends to hide the eye during side gaze, causing the eyes to appear crossed. This appearance of strabismus may improve as the child grows. True strabismus is not outgrown. An ophthalmologist can readily distinguish true from false strabismus.

Treatment

Treatment goals for strabismus are to preserve vision, to straighten the eyes, and to restore binocular vision. Depending on the cause of the strabismus, treatment may involve repositioning the unbalanced eye muscles, removing a cataract, or correcting other conditions which are causing the eyes to turn. After a complete eye ex­amination, including a detailed study of the inner parts of the eye, an ophthal­mologist can recommend appropriate opti­cal, medical or surgical therapy. Covering or patching the good eye to improve vision in the amblyopic eye is often necessary.

Esotropia

The two most common types of strabis­mus are esotropia and exotropia. Esotropia describes an inward turning eye and is the most common type of strabismus in in­fants. Young children with esotropia do not use their eyes together. In most cases, early surgery to align the eyes is needed to obtain binocular vision and prevent per­manent vision loss.

During surgery, the tension of the eye muscle in one or both eyes is adjusted. For example, in surgery for esotropia, the tight inner muscles may he removed from the wall of the eye and placed further back on the eye. This weakens their pull and allows the eyes to move outward. Sometimes the outer muscles are tightened by shortening the muscle length to allow the eyes to move outward.

Accommodative Esotropia

Accommodative esotropia is a common form of esotropia which occurs in far­sighted children, usually two or older. When a child is young, they can focus their eyes to adjust for the farsightedness but the focusing effort (accommodation) re­quired to see clearly stimulates the eyes to cross.

Glasses reduce the focusing effort and can straighten the eyes. Sometimes bifo­cals are necessary for close work. Eye drops, ointment or special lenses called prisms can also be used to straighten the eyes. Eye exercises occasionally help older children.

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