Strabismus

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Strabismus is an abnormal condition. Adult strabismus surgery seeks to restore/reconstruct normal ocular alignment and is not surgical enhancement for cosmesis.

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Description of Strabismus

Here are some indications for Surgical Intervention in Adult Strabismus

1. Diplopia. Diplopia, which is the perception of the same image in two different visual directions, is debilitating. It causes a reduction of reading, driving, and vocational skills. Diplopia occurs when an adult has strabismus related to a medical or neurological condition, such as diabetes,1 thyroid/Grave's disease,2,3 myasthenia gravis, brain tumor, head trauma, or stroke.4,5

Diplopia can also develop in the adult who has had childhood strabismus. The mechanism for new onset diplopia in someone with long-standing strabismus has to do with a phenomenon called the suppression scotoma (blind spot). This is an area of the visual field of one eye which is not recognized (i.e. suppressed) by the brain when a child has misaligned eyes. It is specific for the amount and direction of the ocular misalignment. A suppression scotoma prevents diplopia in stable childhood strabismus.6 However, after the visual system has matured (about 8 years of age), if the direction or amount of the misalignment changes, the brain can no longer adjust the suppression scotoma and keep the second image out of sight, causing new diplopia. Restoration of ocular alignment often relieves diplopia, thereby allowing the patient to resume normal visually directed activities at home and at work.1,7

2. Visual Confusion. Visual confusion, the perception of two different images superimposed onto the same space, is also a symptom of ocular misalignment. This symptom can result from newly acquired strabismus or from change in the direction or amount of ocular misalignment in adults with childhood strabismus.8 Visual confusion is particularly debilitating when driving. The affected individual may describe a car "crossing over the center line and coming straight at them," when, in fact, the brain is shifting the image of the car and superimposing it on the road ahead. Surgical correction or reduction of the ocular deviation will usually relieve visual confusion.

3. Restoration of Binocular Vision. Whenever the eyes are not aligned, there is loss of binocular vision or fusion (unification of images) that lets us appreciate depth in three dimensional space. The majority of adults with childhood strabismus who have had surgery to correct their strabismus as adults can regain fusion postoperatively.1,7,9 Even adults with long-standing sensory deprivation have been shown to regain fusion after restoration of sight and alignment.10

4. Intolerance of Prism Glasses or Patch. A small degree of ocular misalignment, which is the same in all directions of gaze (concomitant), may be treated with prism glasses. Prism glasses shift the images over, relieving diplopia and visual confusion while restoring normal depth perception. This benefit occurs only while the prism glasses are being worn. Prism glasses compensate for but do not "cure" strabismus.

If the size of the deviation is large, prism glasses become too heavy and distorting to be practical. Also, if the amount of ocular misalignment changes in different gazes (incomitant strabismus), prisms will not correct diplopia in those gazes because the degree of prismatic correction does not change when the eyes move. Most adult strabismus is incomitant,7 and therefore is not usually amenable to treatment with prism glasses.

Patching can relieve diplopia by blocking out the vision in one eye. However, this approach precludes all binocular function and limits peripheral field. Use of a patch is usually a temporizing measure until spontaneous resolution or definitive treatment (i.e. surgery) occurs.

5. Restoration of Visual Field. Peripheral vision is recognized as an important prerequisite for highway safety and other daily activities. Loss of visual field loss can be a contributing factor in motor vehicle accidents.11-13 Adults who are esotropic (ocular deviation toward the nose) have a reduced field of vision on the side of the deviated eye. Adult patients with childhood esotropia have a significant expansion of the binocular visual field after surgical realignment of the eyes.14,15

6. Elimination or Improvement of Abnormal Head Posture. Longstanding or newly acquired strabismus in adults is frequently associated with a compensatory head posture, such as a face turn or head tilt, which permits the person to eliminate and/or reduce double vision. The compensatory head position is frequently associated with neck muscle contratures that can be improved with eye muscle surgery.

7. Psychosocial Function/Vocational Status. The presence of strabismus precludes normal eye contact, which is a significant disability in social and vocational settings. Strabismus can have a negative impact on an individual's employment opportunity, school performance, and self image.16-18 The presence of strabismus on a resume photograph when compared to the same resume with the photograph depicting straight eyes, resulted in significantly lower ratings by observers of the applicant's attentiveness, competency, emotional stability, intelligence, leadership abilities, communication and organizational skills, sincerity and employability.19,20

Summary of Strabismus

Adult strabismus results in visual and psychosocial disabilities. Affected individuals may not be offered appropriate surgical treatment because of misconceptions about adult strabismus. Successful strabismus surgery can relieve diplopia and visual confusion, restore or establish depth perception, expand the visual field, eliminate an abnormal head posture and improve psychosocial function and employability.

Adults with strabismus should consult their ophthalmologist about the relative risks and benefits of surgery. Recommendations in this policy statement do not indicate an exclusive course for treatment or procedure to be followed. Variations, taking into account individual circumstances, may be appropriate.

Medical Facts

How You Will Feel:

How Long Will you stay in Hospital after your Strabismus?
Single Day In-patient Care

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We work with hospitals across the world including France, UK, Canada, India, Pakistan, Malta and Hungary to provide our patients with the most appropriate levels of care and treatment

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Related Resources about Strabismus

Why Travel for Strabismus .

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