There are many types of strabismus. The most common one is the inward deviation of the eyeball, which is medically called esotropia and is commonly known as "cross-eyed" or "cross-eyed". The eyeball is deflected outward, which is called exotropia, commonly known as "squinted white eye". Of course, strabismus does not only refer to cases where there is an obvious deformity in the relative position of the two eyes, but also includes cases where the slant is very small, difficult to detect on the surface, and the visual function of both eyes is abnormal. It also includes cases where there is no squint at all but the eyes are abnormal. . Therefore, the concept of strabismus should be understood as an abnormality in the relative position of the two eyes and the function of binocular vision.
Why is strabismus prone to occur in childhood? The main reasons are as follows:
(1) Imperfect development: Children, especially infants and young children, have imperfect binocular single vision function and cannot coordinate extraocular muscles well. Any unstable factors will cause Can promote the occurrence of strabismus. Human's single vision function develops gradually the day after tomorrow. This function, like the visual function, is gradually developed and matured by repeated stimulation of clear objects from the outside world. Babies only have gross fusion 2 months after birth, and the establishment of precise fusion function will continue until after the age of 5. Stereoscopic vision is established at the latest, and it is close to adults at the age of 6 to 7 years. Therefore, the period before the age of 5 when the monovision function of both eyes is not perfect is the period of high incidence of strabismus in children.
(2) Congenital anomalies: This kind of strabismus is mostly caused by congenital abnormal development of the extraocular muscles, abnormal development of the extraocular muscles themselves, incomplete mesodermal differentiation, poor eye muscle separation, abnormal muscle sheaths and fibers. It is caused by anatomical defects such as anatomy or paralysis of the nerves that control the muscles. In some cases, the use of forceps during delivery causes injuries to the baby's head and face, or the mother's excessive force during delivery causes the fetal intracranial pressure to increase, resulting in spot-like hemorrhage in the brain. The bleeding happens to cause paralysis of the extraocular muscles at the nerve nucleus that controls eye movement. In addition, there are also genetic factors. Strabismus is not inherited in all members of the family. This defect is often indirectly passed on to the next generation of children. Generally, strabismus that occurs within 6 months of birth is called congenital strabismus. It does not have the basic conditions for establishing binocular vision and is the most harmful to the development of the visual function.
(3) The characteristics of eyeball development make children susceptible to strabismus: Because children have small eyeballs and short axial length, most of them are hyperopic. Also, because children have large refractive power of the cornea and lens, and strong ciliary muscle contraction, That is, the adjustment power is strong. Such children need more adjustment power to see objects clearly. At the same time, their eyes also turn inward to produce excessive convergence, which can easily cause esotropia. This type of esotropia is called accommodative esotropia.
(4) Insufficient control of the eye movement center: If the abduction is too strong or the abduction is insufficient, or both exist at the same time, esotropia will occur; on the contrary, if the abduction is too strong, the abduction is insufficient, or both exist at the same time, esotropia will occur. Exotropia occurs.
What are the dangers of strabismus?
Because strabismus affects appearance, children with strabismus are often nicknamed, which casts a shadow on the children's psychology and causes them to be withdrawn and abnormal. In general, most children with strabismus have reduced vision in their strabismus to varying degrees, especially monocular strabismus.
Patients with alternating strabismus may have normal vision in both eyes, but they can only focus with one eye. In addition to not having as wide a field of view as normal people, more importantly, they have no fusion ability and stereoscopic vision, and cannot accurately distinguish The distance before and after the object. People with strabismus cannot engage in jobs that require stereoscopic vision, such as driving and surveying.
There are also some patients with paralytic strabismus who have double vision due to ophthalmoplegia. In order to overcome diplopia, they use special head positions such as head tilt, side face, and chin lift to compensate. Medically It is called "compensatory head position". For children, this not only affects the appearance, but also leads to systemic skeletal deformities.
It can be seen that the harm of strabismus not only affects beauty. In order to reduce and avoid the above-mentioned serious complications, it must be taken seriously and treated as early as possible.
Why should strabismus in children be detected and treated early?
Early detection and early treatment of strabismus in children are determined by the development characteristics of children’s visual function. It can be seen from the table that the visual reflection of the eyes in infancy and early childhood is in an unstable state. The fluctuation gradually decreases in the future, basically stops at the age of 5, and the fluctuation period basically ends at the age of 8. If there are no serious obstacles, it will remain lifelong. However, during this unstable period, any disorder that affects binocular vision can lead to strabismus, and any strabismus will lead to the loss of binocular monovision. On the other hand, since the monovision function of both eyes is unstable during this period, it is easy to lose and recover. If strabismus is discovered, seek medical attention and receive treatment as soon as possible. Not only can strabismus be corrected, but the lost or underdeveloped monovision function of both eyes can also be restored. be restored, thereby achieving the ideal goal of functional healing. On the contrary, if treatment is delayed and the visual function development period is missed, the loss of single vision function, skeletal deformity, and compensated head position will not be restored. Even if the strabismus is corrected through surgery in the future, it will only be a cosmetic correction, and without the "gluing" function of binocular monovision, there is still a risk of strabismus reappearing.
Why is hyperopia prone to esotropia and myopia prone to exotropia?
Normal people do not need to adjust when looking far, but when looking close, they need to use +3.0D adjustment. But for people with farsightedness, the adjustment used for near vision needs to add the degree of farsightedness.
When the eyes look at near objects, they produce a near reflex. When adjusting, they turn their eyes inwards to produce convergence. Patients with high hyperopia use more adjustments to see objects than normal people, so they produce more convergence than normal people. The eyeballs are in a state of excessive inversion. , esotropia occurs, which is more common in children with hyperopia of +2.0 to +9.0D. Among them, the esotropia caused entirely by over-accommodation is called complete accommodative esotropia. Wearing hyperopia glasses for this kind of esotropia can completely correct the esotropia; in addition to the over-accommodation factor, the other part of the esotropia also has abnormal development of extraocular muscles. factor, called partial accommodative esotropia. Esotropia can only be partially corrected after wearing glasses, and remaining esotropia requires surgical treatment.
Myopia, especially high myopia, must place objects very close to see clearly. At this time, high myopia patients do not need to adjust like normal people, but they must use force to see near at the same time. Vergence, which causes the eye's adjustment and convergence to be inconsistent, causing eye fatigue. In order to avoid fatigue, people often give up convergence on their own. As time goes by, the convergence function becomes weaker and weaker, and one eye will deviate outward, resulting in exotropia. The eye with exotropia is generally more myopic and has lower visual acuity than the other eye. Usually, the good eye is used to see things, resulting in strabismic amblyopia. The single vision function of both eyes is gradually lost, making the exotropia more serious. ?
Will children with good vision suffer from strabismus?
Clinically, some children with strabismus have good vision in both eyes. This is because their eyes can look alternately. Although they have strabismus, it does not affect the visual development of both eyes. Clinically, it is called alternating strabismus. It is not caused by abnormal eye adjustment, but non-accommodative strabismus. The cause is an imbalance in the brain's control of eye abduction and collective movement or an imbalance in the development of extraocular muscles.
So, children with good vision may still suffer from strabismus, but it is worth noting that although they have good vision, their eyes have been deviated since childhood, and most of them have lost the function of single vision in both eyes. Non-surgical treatments such as wearing glasses for strabismus are often ineffective. Surgery should be performed as soon as possible to ensure that the visual axes of both eyes are parallel after surgery, thereby increasing the possibility of obtaining monovision function or obtaining peripheral fusion.
Why does strabismus occur at different ages in children, and what is the relationship between age of onset and efficacy?
Generally speaking, congenital esotropia occurs very early and the degree of strabismus is relatively large. However, within 6 months of birth, even if a slight misalignment of the eye position is found, it cannot be immediately concluded that strabismus is present. Because normal baby's eye movements are uncoordinated 2 to 3 months after birth, there may be slight deviation. Between 5 and 7 months of age, the convergence reflex gradually forms, vision develops to a certain level, and eye movements are coordinated. If there is eyeball deviation at this time, further examination should be performed. Generally, those with onset within 6 months of birth can be diagnosed as congenital strabismus.
As age increases, between the ages of 2 and a half to 3 years old, a relatively strong relationship is established between accommodation and vergence. Accommodative esotropia is most likely to occur at this age, and this type of esotropia is rare within 2 years of age. If it occurs within 1 year of age, it can almost be determined that it is not accommodative esotropia, because the binocular visual reflex is unstable at this time, and there is no stable relationship between accommodation and convergence.
The onset of exotropia is early after birth, but it is often intermittent at first, and the intermittent period is relatively long. It is not discovered until the exotropia occurs frequently or can be seen most of the time, so most people think Exotropia appears to occur later than esotropia. Exotropia in children is mostly discovered between the ages of 4 and 5.
The greater the impact of strabismus on visual development, the less likely it is to be functionally cured. Children's strabismus occurs at different ages, and the curative effects are also different. The earlier strabismus occurs, the greater the impact on the development of binocular monovision function, and the worse the curative effect; the later the strabismus occurs, the more fully developed binocular monovision function is, and the better the curative effect. In the early stage of onset, strabismus with intermittent periods has better curative effect than strabismus without intermittent periods. Children with exotropia are better treated than esotropia. Congenital esotropia should generally be treated surgically at the age of 2 years. Relatively speaking, strabismus with a later age of onset has better treatment effects. Of course, strabismus in children should be treated as soon as possible as soon as it is discovered, otherwise the treatment opportunity will be delayed.
Can strabismus be completely cured?
The clinical effects of strabismus treatment are as follows: ① Complete functional cure. Also called Level I functional cure, the patient has normal or similar vision in both eyes; has normal retinal correspondence and fusion; the eye position is normal or has a very small amount of phoria under any circumstances, but the patient can maintain both eyes in daily work and life Single vision. ②Incomplete functional cure. This category includes many types. The better ones may only have defects in one of the above items, but the retina is still normal, which is also called Level II functional cure. For worse cases, the retinal correspondence may be abnormal (such as some small-angle strabismus), but there is indeed a certain degree of monovision and fusion ability of both eyes, which is different from monovision, and is also called Level III functional cure. ③The patient has no binocular monovision function at all and only has an improvement in appearance.
Early treatment of strabismus in children is key to whether children can establish and consolidate binocular vision and whether they can protect and restore normal vision. For children with strabismus whose normal retina has been destroyed and no binocular vision function, treatment before the age of 7 is easier to restore binocular vision function. Treatment over the age of 15 can only achieve the cosmetic purpose of correcting the appearance of strabismus.
What are the treatments for strabismus?
The causes and types of strabismus in children are different, and the treatments are also different.
(1) Different treatment methods are adopted according to the degree of strabismus: For asymptomatic phoria, no treatment is needed because children have strong fusion and convergence abilities. However, some children with phoria have short vision at close range. Symptoms of visual fatigue such as eye swelling, orbital soreness, headache, etc. can be treated appropriately. For esophoria, pupil dilation and optometry are required, and for hyperopia, appropriate glasses should be worn. For exophoria, vergence training can be done to strengthen the strength of the adductor muscles of the eyes to overcome exophoria. If the effect is not good, you can also wear prism glasses to improve your vision. For exophoria that is more than 10° (20Δ), surgical treatment may be considered.
Intermittent esotropia is mostly hyperopia. Once it is discovered, it should be dilated and refracted, and sufficient glasses for hyperopia should be worn to correct it. After wearing glasses, the intermittent esotropia can be completely corrected.
Children with intermittent exotropia should undergo strabismus and homotropia examinations to understand their binocular vision function, and undergo surgical treatment as soon as possible before the monovision function of both eyes is lost. If the single vision function of both eyes is lost, it is still possible to return to normal through surgical correction before the age of 7. If the degree of strabismus is very small, you can wear negative lenses and conduct convergence training, but this can only alleviate the symptoms and is not easy to cure.
For dominant strabismus, in addition to accommodative esotropia, early surgical treatment is often required.
(2) Different treatment methods are adopted according to different causes of strabismus: ***Congenital esotropia among homo strabismus has nothing to do with eye adjustment, but it has a great impact on the development of binocular single vision function. The best Treatment is surgical correction at the early stage of visual function development at the age of 2 years. Esotropia that occurs after 2 to 3 years of age is mostly related to excessive accommodation vergence caused by hyperopia. This kind of strabismus should be fully dilated and refracted. People with hyperopia should wear enough glasses and wear glasses for 3 to 6 months to correct or partially correct the strabismus. After correction, the remaining esotropia is surgically treated. If the esotropia does not change after wearing glasses, surgical treatment is the only option. If the strabismus is completely corrected, you can continue to wear glasses. If the degree of hyperopia is very high, you can also correct the strabismus through surgery and reduce the degree of glasses.
For patients with dominant exotropia, after excluding obvious refractive errors, the treatment principle is also early surgery. If you have poor vision, you need to fully dilate your pupils and undergo refraction. If the exotropia is caused by no adjustment, you should always wear appropriate myopia glasses. The exotropia may be corrected. If you have hyperopia combined with amblyopia, you should wear glasses according to the principle of using the lowest lens power to achieve the best corrected vision, and perform amblyopia training. If exotropia still exists, surgical treatment is required.
Children’s paralytic strabismus is mostly caused by congenital developmental abnormalities, birth trauma and illness within a few months of birth. The cause of the disease should be found first, and consultation should be conducted with otolaryngology, neurology, brain surgery, pediatrics, etc. to rule out diseases such as periorbital sinuses, cranial nerves, and intracranial tumors, accurately diagnose the primary disease, and prevent delays in treatment. In addition to treating the cause of paralytic strabismus, oral and intramuscular injections of vitamin B1, vitamin B12, inosine, coenzyme A, ATP, etc. can also be used to treat paralytic strabismus. Acupuncture and physical therapy can also be used to promote the recovery of paralyzed muscles. If the disease cannot recover after half a year of treatment, surgical treatment may be considered. However, most paralytic strabismus in children is congenital, and surgical treatment is still the main method, because congenital paralytic strabismus has little chance of forming amblyopia, and monovision function is often maintained due to compensatory head position; even if the monovision function of both eyes is incomplete or lost , as long as the operation time is early and the operation is performed appropriately, the eye position can be corrected, the compensated head position will soon disappear, and the single vision function of both eyes will be restored quickly, achieving the purpose of functional cure.
Why do children with strabismus need dilated optometry and glasses treatment?
Judging from the close relationship between accommodation and strabismus, hyperopia is prone to esotropia, and myopia is prone to exotropia. In addition, good vision is the basis for normal retinal correspondence and simultaneous fixation of both eyes. Different vision can also cause strabismus and amblyopia. It can be seen that strabismus, amblyopia and refractive abnormalities are closely related, so mydriasis refraction is the first step to check for strabismus in children. Wearing glasses to correct refractive errors is an important method for treating strabismus in children. Children with strabismus who have refractive errors, especially those with esotropia who develop hyperopia between the ages of 2 and 3, should wear glasses for treatment, because the treatment with hyperopia correction glasses is particularly effective at this time, which can correct the excessive adjustment of the eye and convergence. After the esotropia returns to normal, many children only need to wear glasses for a period of time, and their esotropia can be completely corrected.
The refraction of children with strabismus must undergo sufficient cycloplegia, that is, full pupil dilation, because children’s ciliary muscles are very strong and have strong adjustment ability, and it is easy to cover up the true refractive power due to adjustment, especially It is hyperopic refractive error, and refraction without dilated pupils is inaccurate.
Another reason why children with strabismus require mydriatic optometry and glasses is that many children with strabismus are combined with amblyopia. A small number of them are caused by strabismus, and most of them are caused by the combination of refractive error or anisometropia or two or more reasons. Caused by both. While treating strabismus, amblyopia needs to be treated, and the primary method for amblyopia examination and treatment is dilated optometry and glasses (see below for details).
Why do children who wear glasses need an optometry test every year?
This is because the refractive state of the eyes changes with age. For example, for hyperopia, this change does not always mean that the degree of hyperopia becomes smaller and smaller with age. Instead, the degree of hyperopia in some children tends to increase, reaching the peak of hyperopia by the age of 6 to 7, or even 8 years old. It reaches its peak, and then gradually decreases with age. In view of this situation, children who wear glasses are required to have their pupils re-optometrically dilated once a year. For children with esotropia who wear spectacles for correction, those aged 2 to 3 years old are required to have their eyes re-opted once every six months. Each time, the next treatment plan is determined based on the change in diopter and the correction of strabismus.
If the strabismus completely disappears after wearing glasses, the prescription of hyperopia correction glasses can be gradually reduced to a level where the strabismus can be controlled and good visual function of both eyes can be maintained. It is not right to keep wearing the original glasses. This is because the hyperopia of normal children decreases rapidly in the first few years of life during the development process. Although children with accommodative esotropia have larger hyperopia, they also tend to have less hyperopia. Therefore, long-term wearing of initial fully corrective glasses may affect their development of emmetropia. Some patients who wear fully corrected glasses for a long time will have a receding near point of accommodation, accompanied by a receding of the convergence near point, due to weakened accommodation or limited development of accommodation ability. For children with strabismus, the prescription of hyperopia lenses should be reduced gradually within the range of preventing strabismus from relapse. Otherwise, the development of the anisotropic fusion reflex will be affected, and sudden removal of glasses may lead to recurrence of esotropia and blurred vision. Regular dilated optometry every year and timely adjustment of glasses prescription can prevent the above situation from happening.
What precautions should be taken when children with strabismus wear glasses?
The main purpose of wearing glasses for children with strabismus is to correct the eye position, followed by improving vision. If a child with strabismus is combined with amblyopia, his vision will not improve immediately after wearing glasses, but will gradually improve through training. Unlike myopia glasses, which immediately feel clear and comfortable to the eyes after wearing them, it is easy for children to accept them. However, most children with strabismus wear hyperopia glasses, especially glasses that correct esotropia. When they first wear them, their vision is not improved, but their vision becomes blurry. Some also cause dizziness, vertigo, etc., which require an adaptation process, so many children are reluctant to wear them.
This phenomenon is mainly due to the fact that the power of hyperopia glasses is determined by using atropine to dilate my pupils and complete ciliary muscle paralysis, and the glasses are worn in full. When the pupil is dilated, the diopter feels appropriate. Once the pupil returns to normal, the ciliary muscle returns to a tense state. Part of the hyperopia diopter is masked by excessive adjustment, and it is difficult to adapt to it when you first wear it. In order to achieve the purpose of treatment, children should be forced to wear glasses. After a period of time, the ciliary muscles are forced to gradually relax and they will adapt to wearing glasses. When a few children still cannot adapt, they can apply atropine eye ointment every other day or once a day for 3 to 5 days to allow the ciliary muscles to relax again before wearing glasses. The symptoms of discomfort will disappear until the pupils recover to normal. Normally, the children will adapt.
After the glasses are fitted, they must be worn continuously without interruption and cannot be taken off except for sleeping. Otherwise, if you stop wearing the glasses for a few days, the ciliary muscles will become tense again, and the above-mentioned discomfort will occur again when you wear the glasses again. Children with accommodative esotropia generally need to wear it for 3 months to half a year before the effect can be seen, so they should not be rushed.
When children wear glasses and play, to prevent the glasses from being broken, they can tie an elastic band on the temples and tie them behind the head to fix them. To prevent the lenses from breaking and damaging your eyes, you can wear unbreakable resin lenses. However, resin lenses are not wear-resistant and need to be protected.
After wearing glasses, children with strabismus should go to the hospital for regular check-ups, usually once every 1 to 2 months, to observe the changes in strabismus and improvement in visual acuity after wearing glasses, so that the doctor can understand the treatment effect at any time and adjust the results according to the patient's needs. Formulate the next treatment plan based on the child's changes and adjust the degree in a timely manner.
Can strabismus correction glasses eventually be removed?
For children with accommodative esotropia who wear glasses for correction, most of them can take off their glasses. After strabismus is corrected by wearing glasses, the prescription of glasses should be gradually reduced based on the decrease in hyperopia at each refraction and on the premise that the esotropia does not recur. At the same time, children with amblyopia need to undergo amblyopia training to improve their vision and restore the single vision function of both eyes. In this way, the degree of hyperopia is reduced to the point where the strabismus eye is completely aligned without wearing glasses, the visual acuity and single vision function of both eyes return to normal, functional healing is achieved, and the glasses are removed.
For some children with accommodative esotropia, whose eye position cannot be completely corrected after wearing glasses for more than half a year, they can continue to wear glasses to treat amblyopia after surgery to correct the strabismus to consolidate the eye position, and eventually they can often take off their glasses.
Generally, exotropia is often combined with moderate to high myopia. Although exotropia can be corrected by wearing glasses, the degree of myopia tends to continue to increase with age. It is not easy for such children to take off their glasses. .
In short, many children with esotropia combined with hyperopia can eventually take off their glasses, which mainly refers to mild or moderate hyperopia (+3.00D ~ +6.00D). People with high hyperopia or myopia greater than +6.00D may need to wear glasses for life to obtain normal vision.
Which strabismus requires surgical treatment?
Clinically, except for accommodative esotropia caused entirely by excessive hyperopia and excessive convergence, which can be completely corrected by wearing glasses, other types of strabismus basically require surgical correction. Obtaining a certain degree of fusion function after strabismus surgery will help maintain eyeball alignment. Eyeball alignment can restore normal or a certain degree of stereopsis to some patients. In particular, patients with intermittent or recent onset of disease are expected to obtain good binocular monovision. Function. Therefore, no matter what kind of strabismus, if conservative methods and training therapies are ineffective, surgery can restore the normal and coordinated function of the eye muscles. The strabismus will not only change to the upright position when it is in the original position, but also move in all directions synchronously, and the eyes can be single. Anyone with vision, stereopsis, and no adverse complications can be operated on.
Patients with phoria or intermittent strabismus often report eye fatigue, which seriously affects their work. Once conservative treatment (such as wearing negative lenses or prisms, etc.) fails, surgical treatment may also be considered.
Surgical correction of eye position can reduce excessive concentration, eliminate over-adjustment, and reduce and eliminate symptoms of visual fatigue.
Some patients often display compensatory head positioning in order to eliminate diplopia or improve vision. Head deviation and torticollis are severe and affect the appearance. If surgery can compensate for the head position without complications, it can also be used as an indication for strabismus surgery.
In cases of paralytic strabismus or other non-homosexual and homosexual strabismus, patients often complain of diplopia. When wearing glasses and conservative treatment for more than half a year are ineffective, strabismus surgery can eliminate the diplopia. , restore binocular single vision in one or more diagnostic eye positions. For example, if strabismus surgery can only correct or basically correct the eye position to achieve certain cosmetic purposes, and the patient has understood it before surgery, it can also be used as an indication for strabismus surgery.
When is the best time to have surgery for strabismus in children?
For congenital esotropia discovered after birth or within 6 months, surgery should be performed at 1 to 2 years old before the binocular monovision function develops; for esotropia that occurs after 6 months, surgery must not be performed immediately, and surgery must be performed immediately. It is necessary to have mydriasis checked first. If there is hyperopia, wear sufficient corrective glasses for 3 to 6 months. If the esotropia is completely corrected, there is no need for surgery. You can cure it by continuing to wear glasses. If you wear glasses for more than 6 months, the esotropia will only be cured. If the strabismus is reduced, the remaining strabismus should be operated on as soon as possible. If the strabismus does not change after wearing glasses, the operation should be performed as early as possible. For monocular esotropia, covering therapy can be used first to turn it into alternating strabismus, and then surgery is performed, which is more beneficial to restoring the single vision function of both eyes. If covering for more than half a year is still ineffective, surgery can also be performed.
Children with exotropia should undergo early surgery, especially for intermittent exotropia. Although there are conservative treatment methods such as negative mirror treatment and convergence training, these methods can only reduce the degree of strabismus and cannot cure it. Surgical treatment is the first choice for this disease, and should be corrected as early as possible before significant exotropia is formed and the monovision function of both eyes is not completely lost. For this disease, surgery is best performed at the age of 4 to 6 years.
The vision in both eyes is normal, and there is no obvious refractive error with dilated pupils, which proves that the treatment with glasses is ineffective and surgery should be performed as soon as possible. For intermittent strabismus whose degree of strabismus is very small and often changes, surgery is postponed to see if it can heal on its own. If the degree of strabismus gradually increases, it is not too late to perform surgery.
In principle, children with strabismus and amblyopia should be treated for amblyopia first and then for strabismus. Only when vision is improved can the effects of surgery be consolidated. However, for large degrees of strabismus, the strabismus must be corrected first, otherwise the strabismic eye cannot gaze well and the amblyopic eye cannot be well treated. For esotropia and exotropia that are complicated by intraocular diseases and the vision cannot be restored, surgery should be performed after the age of 12 to prevent exotropia or exotropia recurrence without binocular vision control after surgery.
Congenital paralytic strabismus, especially children with compensated head position, should be surgically corrected at about 3 years old. For acquired paralytic strabismus, efforts should be made to find the cause and cooperate with drug treatment. After half a year Only those who fail to respond to treatment may consider surgery.
Do I still need to wear glasses after strabismus surgery?
Many children with strabismus wear glasses before surgery. Since the purpose of wearing glasses varies, whether to wear glasses after surgery should depend on the specific situation. As a general rule, the vision after strabismus surgery is still not normal. If wearing glasses can improve vision, you should continue to wear glasses after surgery.
Children with esotropia who originally wore hyperopic glasses will have their eyes in the upright position after surgery with and without glasses. However, if wearing glasses is helpful for vision, in order to further treat amblyopia, the original glasses can still be worn. Or low prescription glasses. If the original hyperopia degree is less than +3.00D and the naked eye vision is normal, you do not need to wear glasses, which is more beneficial to the recovery of binocular vision function. If the strabismus is not corrected enough after esotropia surgery, you still need to wear high-power hyperopia glasses to facilitate the correction of the remaining strabismus. For partial accommodative esotropia, because the surgery only corrects part of the esotropia that cannot be corrected by wearing glasses, you need to wear glasses after surgery. In the treatment of fully accommodative esotropia, the original glasses should be worn, and some children may lose their glasses. Children with esotropia who originally wore myopia glasses will have their eye position corrected after surgery, and they will wear myopia glasses at the lowest degree to improve their best vision.
Children with exotropia who originally wore glasses for myopia, but whose eye position is corrected after surgery, still wear glasses of the lowest degree that best corrects vision; if the correction after surgery is insufficient, the myopia degree can be appropriately adjusted and worn. Myopia glasses with a slightly larger power can be helpful in correcting exotropia. If the residual slope is large and wearing glasses is ineffective, another surgery may be considered. Children with exotropia originally wore hyperopic glasses, but their eye position was corrected after surgery. In order to improve their vision, they still need to wear low-power hyperopic glasses.
In short, the purpose of wearing glasses after surgery changes from preoperative correction of strabismus and treatment of amblyopia to single treatment of amblyopia. The power of glasses should be based on the postoperative eye position, corrected vision, and the nature of refractive error. Consider the situation comprehensively.
Strabismus needs to be corrected
Newborns have esotropia when their eyes turn inward when looking at near objects, but disappear when looking at distant objects. When the eyes are deflected outward when looking at an object, it is called exotropia.
Babies, especially newborns, often suffer from strabismus due to poor eye muscle coordination. However, by about 1 year old, as the eye muscles mature, the strabismus disappears. Under normal circumstances, the movements of the two eyes are under the influence of the fusion function of the cerebral cortex, and the eyes are always focused on the target. When looking at near objects, the visual axes of the two eyes converge; when looking at distant objects, the visual axes of the two eyes are parallel, maintaining good single vision. If there is an imbalance in maintaining the normal position of the eyeball, strabismus will form. The eye whose visual axis looks at the target is called the fixating eye, and the eye whose visual axis deviates from the target is called the strabismus eye.
Strabismus can be divided into two types:
(1) ***Homosexual strabismus occurs when children's binocular vision begins to form. Because the cortical visual center is immature, a state of eye position separation occurs. Children around 3 years old on windy days.
(2) Non-homosexual strabismus (also known as paralytic strabismus) is caused by paralysis of the cranial nerves (3rd, 4th, and 6th cranial nerves) that control eye movement. Strabismus not only affects the appearance of children's faces, but also affects the development of vision. If we focus our eyes on an object very close to the eyeball, double vision will occur, and one thing will become two. Over time, the object seen by the squinting eye will be suppressed by the cerebral cortex, so that the squinting eye is equal to It's no use. Over time, due to disuse, amblyopia gradually develops, vision declines, and there is no sense of three-dimensionality when seeing objects. In the future, it will be unable to perform fine work or work that requires normal three-dimensional vision.
Once a child has strabismus, he or she needs to go to the ophthalmologist for further examination. Sometimes it is only necessary to correct the refractive error, while in other cases, surgery is needed to correct it.