Types of Strabismus (Deviation of the eye)

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If you’re just learning about strabismus, or an eye turn, you may be confused about exactly what it is. In fact, there are many variations of strabismus defined by a number of factors. Ultimately, the nature of the eye turn dictates the approach doctors take with vision therapy.
When assessing a strabismus patient, there are generally six factors doctors consider, including direction, frequency and severity of the eye turn. Fortunately, regardless of the type, vision therapy can help strabismus patients improve their vision. Six Defining Factors of Strabismus are:

 

Direction of the eye turn

Although many people refer to strabismus as crossed eyes, the eyes can in fact turn in any direction including: up (hypertropia), down (hypotropia), inward (esotropia), outward (exotropia), or in rare cases, rotationally (cyclotropia).

Exotropia and esotropia are the most common types of strabismus, but a patient could also have a combination, such as one eye pointing inward and down (hypotropia and esotropia). Cyclotropia more commonly exists with other types of strabismus.

Frequency of the eye turn

Next, doctors want to know how often the eye turn occurs. Either the eyes are always misaligned (constant strabismus) or only some of the time (intermittent strabismus).

If a patient has intermittent strabismus, doctors try to determine when it happens and what’s triggering the turn. For some patients, the turn may occur at seemingly random times. For others, it may be a more specific catalyst, such as becoming tired.

Although doctors can tackle either case, it is more difficult to treat a patient with constant strabismus. It’s much more difficult to train someone’s eyes to work together when they’ve rarely or never done so before.

Which eye is affected 

An eye turn can occur in one eye or both. doctors need to determine which eye is affected so we can train that eye to properly respond to neural signals, eventually helping it work together with its counterpart.

Additionally, if only one eye is turned constantly, it can cause amblyopia, or what many people refer to as a ‘lazy eye’ (not a clinical term). This is because an eye turn can cause a patient to see double, which is difficult for the brain to process. To compensate, the brain will begin to solely depend on the non-strabismic eye for viewing, suppressing information from the strabismic eye.

Extent of the eye turn

Some eye turns are severe, while others are barely noticeable. The extent of the turn may impact how soon it is detected. A person with a more dramatic eye turn may seek treatment at an earlier age while someone with a more subtle turn may not even know they have a vision problem.

It’s why doctors strongly encourage parents to schedule regular eye exams for their children. The longer strabismus remains untreated, the more embedded it can become. Additionally, undetected strabismus may have associated amblyopia.

Sensory issues

Our brain wants the images received from both of our eyes to fit together like a puzzle. This is difficult for strabismus patients, as their eyes don’t align to create a clear, single image. The result is double vision and/or suppression.

Cause of eye turn

The final thing we need to determine is the cause of the eye turn.
The root cause of a patient’s strabismus plays a big role in treatment options and the extent to which vision therapy can improve the condition.

Strabismus can stem from a variety of accidents or medical complications, such as muscle or nerve damage, trauma, a brain tumor, or an aneurysm. More commonly, it is a condition developed in the first few years of life.

When someone has strabismus, it is a sign that their vision is not working efficiently.

While the types of strabismus may differ, the goal of treatment is the same: Getting the entire visual system to work as efficiently as possible so that it doesn’t negatively impact a person’s performance in school, work or sports.

Post-operative strabismus care

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After surgery

• When you arrive in the recovery area, you may still be very sleepy.
• Do not try to get out of bed without help the first time you get up.
• • Do not touch your eye dressing until the muscle adjustment has been completed.
  • A light ice bag or cool wet compress may be applied over the operated eye(s) and the head of the bed will be raised to help reduce swelling.
  • To make a cold compress at home, place a clean facecloth in a bowl of ice cubes and water. Wring out the cloth and place it over your eye for 10 minutes 4 times a day.
  • There may be some clear to pink-tinged eye drainage and an itching sensation. This may continue for several days after discharge from the hospital.
  • The eye(s) will be “bloodshot”. This eye redness may not clear for several weeks.
  • Swelling and bruising is generally gone in 1 to 2 weeks.
  • The strabismus surgery may have varying degrees of beneficial effect. Do not be concerned if the eye(s) does not move into good cosmetic position. The effect of surgery is quite variable for the first six weeks.

  Activity and Rest

• • Avoid strenuous activity, such as lifting or contact sports for 14 days following surgery.
  • Sleep with your head elevated on 2 to 3 pillows for 5 to 7 days to reduce pain and swelling.
  • Avoid swimming and activities in which sand or dirt may enter the eye for 14 days.
  • There are no restrictions on reading or watching TV.
  • You may return to school or work as long as you are able to comply with the above activity restrictions, or at your Doctor’s discretion.

  Medication

• • Eye drops or ointment will be put in your eyes after your surgery
  • You may receive a prescription to use at home

  Eye Exercises 

  You may be asked to move your eyes up and down, and from side to side. Do this four times a day for 5 to 10 minutes at a time. This is to make sure that the muscles do not scar and will help you to see in all directions.

  Home Care Instructions 

• • Do NOT rub your eye(s); avoid touching your eyes. Wash your hands before and after eye care.
  • Gently clean your eyelids once a day. Use a clean, wet washcloth. Start cleaning at the inner corner of the eye and wipe outward. Don’t use the same part of the washcloth twice. Avoid pressure on the eye(s).
  • At home, protect your pillow with a towel in case of some drainage leaking from your eye.

  How to Put in Eye Drops

• • Wash your hands with soap and water.
  • Sit in a chair with your medication beside you.
  • Check your medication to make sure you have the correct drops for each eye. Shake the bottle. Remove the bottle cap.
  • Tilt your head backwards and pull your lower lid down toward the cheekbone. Your lower lid will be “cupped” and ready to receive the drops.
  • Use your other hand to squeeze the ordered number of drops into the eye(s). Release the lower lid and gently close your eye for a few seconds.
  • Gently blot any excess medication from the eye area with a clean tissue or cotton ball.
    • If more than one medication is ordered for the same eye, wait a few minutes before using the next medication. Always put in drops before ointment.

  Call doctor

  Notify the Doctor or go to the Emergency Department if any of the following happens:

  • Sudden increase in redness of the eye(s).
  • The area becomes red, swollen, warm to touch and/or you notice pus-like (yellow or green) discharge
  • You develop chills or fever (38.5°C/101.3°F or higher)
  • Continued eye discomfort not relieved by pain medication