An eye that "turns" inwards or outwards is not simply a cosmetic matter. In children, strabismus can interfere with visual development; in adults, it can cause double vision. With proper management, it can be treated.
In brief: strabismus is a misalignment of the two eyes. In children, detecting it early is essential to preserve visual development and prevent a lazy eye. In adults, it can cause double vision. Treatments range from glasses to orthoptic exercises and, in some cases, surgery.
Normally, both eyes look in the same direction and the brain fuses their two images into a single three-dimensional picture. In strabismus, one eye deviates: it may turn towards the nose (convergent strabismus), outwards (divergent), or more rarely upwards or downwards. The deviation may be constant or occur only at certain times, for example when tired.
In very young children, a wide nasal bridge or a skin fold may give a false impression of strabismus: only an examination can distinguish this from true strabismus.
The causes are varied and determined during the examination:
This is the key concern in children. When one eye deviates, the brain, to avoid double vision, "sets aside" the image from that eye. Used persistently, the deviating eye may fail to develop properly: this is amblyopia, or lazy eye. The earlier it is identified, the better it can be corrected, because vision develops during the first years of life.
Strabismus in a young child cannot wait: early detection determines the chances of the affected eye developing good vision.
Strabismus may persist from childhood, or appear in adult life. In the latter case, because the brain can no longer suppress one image, it often produces double vision (diplopia), which can be quite disabling. A strabismus of recent onset in an adult requires investigation, as it may reveal an underlying cause to be identified.
The examination is painless. It measures the deviation, looks for an associated refractive error, and assesses the vision of each eye as well as stereoscopic vision. In children, it is adapted to the child's age and does not require them to be able to read. Measuring the refraction after pupil dilation is often performed.
Management is progressive and tailored to each situation. The aim is first to achieve the best possible vision in each eye, then to correct the alignment.
Wearing glasses corrects the refractive error and sometimes suffices to realign the eyes, particularly in cases of hyperopia.
In children, the lazy eye is stimulated, for example by temporarily patching the good eye, following a supervised protocol.
Orthoptic exercises may be recommended depending on the type of strabismus.
It involves changing the position or strength of certain eye muscles in order to realign the eyes. It is performed under general anaesthesia, most often as a day case.
In some situations, an injection into an eye muscle can temporarily correct the imbalance. It may be used on its own or in addition to surgery.
None of these steps is applied routinely: the treatment plan is defined on a case-by-case basis and explained during the consultation, without any promise of outcome.
Dr Gattoussi, ophthalmologist in Paris 11th, can carry out the assessment and guide the management plan.
True strabismus does not resolve on its own and must be assessed: left untreated, it can lead to a lazy eye. Certain false impressions of strabismus in very young children are not true strabismus.
No. In children, it can compromise visual development and stereoscopic vision; in adults, it can cause double vision.
No. Many cases of strabismus are treated without surgery (glasses, patching, orthoptic exercises). Surgery is recommended in certain situations.
As soon as a deviation is noticed, without delay, and especially in young children.
This article is for general information purposes only and does not replace a consultation. It does not constitute individual medical advice.
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