The long road from bench to bedside
22/04/2024
05/02/2020
Treatment for strabismus includes different therapeutic options that will be considered by the consultant ophthalmologist on a personalised basis.
First, we must fix the refractive error, if there is one, using glasses or contact lenses. In some cases, optical correct alone can make up for the deviation. Second, if amblyopia develops (lazy eye) in the deviated eye, we must restore the sight to that eye. The most effective way of doing so is occlusion of the healthy eye using a patch. If the optical error and amblyopia are fixed and the deviation persists, then surgery will be the next step.
Strabismus surgery
Strabismus surgery is performed on the extraocular muscles, the ones responsible for eyeball movement. During surgery the ophthalmologist will make a small incision in the tissue covering the lower part of the eye (conjunctiva and Tenon's capsule) to access the muscles. Depending on the direction of the deviation, they will be strengthened (shortening their length) or weakened (adjusting their position) for improved alignment of the eyes. Surgery may be required on one or both eyes and one or several procedures may be needed. In 20-30% of these cases, a patient will require more than one procedure in their lifetime.
Where children are concerned, because of their young age, the procedure is performed under general anaesthesia while local anaesthesia can be used on adults. In both cases, it’s an outpatients surgery, meaning that the patient can go home the same day that surgery is performed. The aim of strabismus surgery does not just include improving the similarity of the eyes and their grade of binocular cooperation, it also means eliminating or reducing diplopia (double vision), correcting anomalous head positions (torticollis), reducing visual fatigue and improving the patient's looks and quality of life.
Strabismus surgery is performed on the extraocular muscles, the ones responsible for eyeball movement.
Other therapeutic options
There are other therapeutic options in addition to surgery. These include visual rehabilitation, prisms and botulinum toxin. Botulinum toxin injections are an alternative in certain cases such as oculomotor palsy; orthoptic exercises could be useful as a complement to surgery and in selected cases like phorias and intermittent divergent strabismus; and prisms would be indicated in minor strabismuses that cause diplopia.