Strabismus is the general term for any misalignment of the eyes regardless of type, cause or age of onset. Esotropia (crossed eyes), exotropia (wandering eyes), hypertropia (one eye higher) and hypotropia (one eye lower) are examples. It can be due to either a paralytic (due to a weak or paralytic muscle or nerve) or non-paralytic (due to congenital imbalance or focus problems) this affects approximately 2 to 4 per cent of the population. The most frequent age for strabismus to occur is between 18 months and five years, with a large number of cases occurring between ages two and a half and three and a half.
Vision therapy may be very effective in the treatment of strabismus.
The symptoms described below may not necessarily mean that your child has strabismus. However, if you observe one or more of these symptoms, contact your child's eye doctor for a complete exam.
- Decreased vision
- Misaligned eyes
If you have esotropia the following are some of the symptoms you may experience:
- suppression (turning off) of one image
- eye strain
- problems with depth perception
- slight head tilt
If you have exotropia the following are some of the symptoms you may experience:
- double vision
- suppression (turning off) of one image
- people with intermittent exotropia often develop adaptations that allow them to suppress or ignore the image from the wandering eye and therefore they will not notice the double vision. During the time the eyes are straight, the suppression is absent and both eyes see normally as a team. If the eye turn is constant a lazy eye may develop.
- light sensitivity is also a common complaint.
Most often strabismus is the result of an interference in learning how to use the two eyes. Binocular vision is a learned skill. There appears to be an inborn program and schedule for its development. Sometimes factors such as head injury, a cataract, a droopy eye lid can disrupt the development of binocular vision, usually it comes from an interference in the neural control centers or the ability to attend to and absorb information from both eyes.
Interestingly, researchers have determined that the muscles in patients with strabismus are lacking in certain proteins (myosin, tropomyosin, titin, and troponin). Genetic expression of collagens and enzymes that regulate collagen formation are not sufficiently supported, and genetic expression of collagen-inhibiting enzymes is supported genetically in excess.1
Disturbances in the neural control centers occur with high fevers and childhood illnesses. Sometimes the neural interference occurs for other reasons. This is probably the reason that studies show a relationship between the development of strabismus and the delay in a child's learning to sit, walk, talk, and control elimination functions.
It seems that the mind pays attention more fully to the workings of the visual system between the ages of four months and six years (or most critically between four months and three and a half years). After that period the mind is more critically involved in other learning skills. A delay in neural growth or the protective covering of nerves may put binocular development out of phase with the concentrated attention necessary to convert the eye coordination skills into conditioned habit patterns. If visual habits are not firmly fixed they are then more vulnerable to loss.
For esotropia or exotropia, depending on the type and severity either surgery, glasses and/or visual training can be done. Surgery doesn't change the vision, but aligns the eyes by changing the length or position of one or more eye muscles outside the eye. Sometimes botox is used in the stronger muscle and is repeated 3-4 months later.
Self Help Discussion
- Eye exercises may be recommended by your eye doctor or vision therapist to strengthen and balance eye muscles.
- An eye patch for a child's lazy eye may be recommended to encourage weak eye muscles to strengthen.
- Special eye glasses may be recommended or prism eye glasses to correct vision.
- Working with a vision therapist is a good way to start.
- See all vision therapy products and call us with your questions as to what is appropriate and for vision therapist referrals.
- Manage chronic stress in your life. Chronic, long-term stress has been shown in numerous studies to contribute to serious disease, and is suspected to cause many eye diseases. Managing this stress would go a long way towards helping preserve one's health and vision. There are a number of great techniques including biofeedback, meditation, yoga and tai chi.
- Exercise Maintain a regular, aerobic exercise routine. Fast walking 4-5 times a week is excellent.
- Diet & lifestyle changes - see our recommendations for diet and lifestyle.
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- Binocular conditions
- Palsy of cranial nerve
- Amblyopia (lazy eye)
- Diplopia (double vision)
Research and Information
See a discussion of the research and organizational statements on the efficacy of vision therapy.
1. A.B. Agarwal, C.Y. Feng, et al, Altered Protein Composition and Gene Expression in Strabismic Human Extraocular Muscles and Tendons, Investigations in Ophthalmology and Visual Sciences, October, 2016.