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Squint

What Is Strabismus?

Strabismus is a visual defect in which the eyes are misaligned and point in different directions. The misalignment may always be noticeable, or it may come and go. One eye may be directed straight ahead, while the other eye is turned inward, outward, upward or downward. The turned eye may straighten at times and the straight eye may turn.

Strabismus is a common condition among children, affecting about four percent, but can also occur later in life. It occurs equally in males and females and may run in families. However, many people with strabismus have no relatives with the problem.

Vision and the Brain

With normal binocular (two-eyed) vision, both eyes are aimed at the same target. The visual portion of the brain fuses the two pictures into a single 3­ dimensional image.

When one eye turns, as in strabismus, two different pictures are sent to the brain. In a young child, the brain learns to ignore the image of the misaligned eye and see only the image from the straight or best seeing eye. This causes loss of depth perception and binocular vision. Adults who develop strabismus often have double vision because the brain is already trained to receive images from both eyes and cannot ignore the image from the turned eye.

Amblyopia

Normal alignment of both eyes during childhood allows good vision to develop in ; each eye. Abnormal alignment, as in strabismus, may cause reduced vision or amblyopia. The brain will recognize the image of the better seeing eye and ignore the image of the weaker or amblyopic eye. This occurs in approximately half the children who have strabismus.

Amblyopia can be treated by patching the preferred or better seeing eye to strengthen and improve vision in the weaker eye. If amblyopia is detected in the first few years of life, treatment is often successful. If adequate treatment is delayed until later, amblyopia or reduced vision generally becomes permanent. As a rule, the earlier amblyopia is treated, the better the visual result.

Causes and Symptoms of Strabismus ­

The exact cause of the eye misalignment that leads to strabismus is not fully understood.

Six eye muscles, controlling eye move­ment, are attached to the outside of each eye. In each eye, two muscles move the eye right or left. The other four muscles move it up or down and control tilting movements. To line up and focus both eyes on a single target, all eye muscles of each eye must be balanced and working together with the corresponding muscles of the opposite eye. 

The brain controls the eye muscles which explains why children with disor­ders that affect the brain, such as cerebral palsy, Down's syndrome. hydrocephalus. and brain tumors often have strabismus. A cataract or eye injury that affects vision can also cause strabismus.

The primary symptom of strabismus is an eye that is not straight. Sometimes a youngster will squint one eye in bright sun­light or tilt their head in a specific direc­tion to use their eyes together. Signs of faulty depth perception may also he noticed.

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