Strabismus, commonly referred to as crossed eye, is a condition in which the affected individuals fail to aim at a single object at the same time. Lack of coordination between the eye muscles causes such a condition to develop.
Presentation
Development of crossed eyes and inappropriate alignment of eyes in the same direction are the classical symptoms of strabismus. In addition to these, the eye disorder can also cause double vision, loss of vision, loss of perception of depth and difficulty in moving both the eyes together [6].
Entire Body System
- Swelling
RESULTS: There were significant differences in conjunctival redness and swelling in both groups on postoperative days 1 and 7 and week 3. However, after the third week, both groups had a similar appearance. [ncbi.nlm.nih.gov]
If significant post-operative swelling or discomfort occurs, you can reduce the swelling by applying ice packs to the operated area for 10 to 20 minutes every hour in the evening after you are discharged. [masseyeandear.org]
The onset is acute, with redness, swelling, irritation, and watering of the eye and eyelids, along with a tender swelling of the lymph node in front of the ear. [britannica.com]
This may be somewhat obscured by bruising and swelling. Alignment may, and likely will change as healing occurs. Therefore, no final conclusions about the effectiveness of the procedure can be rendered in the first few days after surgery. [pediatricophthalmologypa.com]
- Asymptomatic
Patients with constant strabismus tend to be less symptomatic (but not asymptomatic) when compared to patients with intermittent strabismus. [seevividly.com]
Furthermore, intracellular S. pyogenes was found in macrophage-like cells in eight (73%) tonsils and in epithelial cells in four (36%) tonsils from 11 asymptomatic S. pyogenes carriers. [mbio.asm.org]
Genetic studies are now available to patients and asymptomatic carriers. [elsevier.es]
It can be carried in the pharynx, skin, vagina, and rectum asymptomatically. There are a wide variety of clinically presentations of GAS. [isid.org]
[…] recession in 2015 Left subnosal 2 weeks Redness The 2nd surgical eye Spontaneous remission NA NA 3 Male 4 Right lateral rectus recession and medial rectus resection Inferior temporal fornix >20 days Conjunctival cyst found Sole operated eye, the 1st muscle Asymptomatic [hindawi.com]
- Rigor
Rigorously designed, conducted, and reported randomized trials are needed to identify the optimal surgical treatment for vertical strabismus in this disorder. [ncbi.nlm.nih.gov]
All Fellows have passed a rigorous national board to receive their certification in the remediation of binocular vision problems. Because of their training and background, C.O.V.D. [fretzvisiontherapy.com]
جماعت, مرتبہ, قبیل, طبقہ, زمرہ, I belong to the middle class / he's a class player / A big class of ninety-nine people / in class / the class of 197 Climb چڑھنے, کوشش سے ترقي کرنا, بلند هونا, اوپر جانا, چڑھنا, We climbed the tree to pluck mangoes / the rigorous [studysite.org]
It is clear that there is no rigorous evidence with regard to preferring surgery before completing amblyopia therapy versus after completing amblyopia therapy. [doi.org]
Gastrointestinal
- Vomiting
Keywords: oculocardiac reflex, nausea and vomiting, anesthesia recovery, topical anesthetic This work is published and licensed by Dove Medical Press Limited. [dovepress.com]
Your child has a severe headache, dizziness, or vomiting. When should I contact my child's healthcare provider? Your child has a fever. Your child has blurred or double vision. You have questions or concerns about your child's condition or care. [drugs.com]
[…] quickly Painful swallowing Red and swollen tonsils, sometimes with white patches or streaks of pus Tiny red spots on the area at the back of the roof of the mouth (soft or hard palate) Swollen, tender lymph nodes in your neck Fever Headache Rash Nausea or vomiting [mayoclinic.org]
The association between the oculocardiac reflex and post-operative vomiting in children undergoing strabismus surgery. Eye (Lond). 1998;12(Pt 2):193–6. 5. Bietti OB. Problems of anesthesia in strabismus surgery. [bmcophthalmol.biomedcentral.com]
It also leaves redness that lasts longer and may cause some vomiting in the early post operative period. The surgeon will provide the patient with a cover for his or her eyes that prevents light from entering. [en.wikipedia.org]
- Nausea
Ideal methods to reduce post-operative pain and nausea are not yet perfected. We postulated that a simple topical anesthetic drop after surgery might help. [dovepress.com]
Unlike childhood strabismus, the adult type usually creates symptoms, such as double vision (diplopia), which may be accompanied by nausea. What Is a Phoria? "Tropia" is another word for strabismus (as in esoTROPIA). [triadpublishing.com]
[…] on quickly Painful swallowing Red and swollen tonsils, sometimes with white patches or streaks of pus Tiny red spots on the area at the back of the roof of the mouth (soft or hard palate) Swollen, tender lymph nodes in your neck Fever Headache Rash Nausea [mayoclinic.org]
Halotane was discontinued and when BIS was ≥ 70 and/or MAC The prophylaxis of postoperative nausea and vomiting (PONV) with Ondansetron 100 mcg/kg -1 IV and dexamethasone 150 mcg/kg -1 IV was realized. [omicsonline.org]
Musculoskeletal
- Muscle Weakness
The preoperative evaluation of these patients must be inclusive for restrictions, redirected muscle forces, adherence syndromes, muscle weakness, and visual sensory disturbance. [ncbi.nlm.nih.gov]
Upper Limb Spasticity The most frequently reported adverse reactions following injection of BOTOX ® for upper limb spasticity include pain in extremity, muscle weakness, fatigue, nausea, and bronchitis. [botoxmedical.com]
Most cases are caused by refractive error or muscle weakness but sometimes a serious disorder is involved (eg, retinoblastoma, cranial nerve palsy). [merckmanuals.com]
- Torticollis
Strabismus may cause permanent loss of three-dimensional vision, amblyopia (visual acuity loss), and/or ocular torticollis. Strabismus can result in significant psychosocial problems for children, which warrant attention. [unboundmedicine.com]
Older children may have double vision or they may have twisting or spasm of the neck (torticollis) to compensate for the misaligned eyes. [msdmanuals.com]
Skin
- Acne Vulgaris
Eva Ritvo, James Q Del Rosso, Mark A Stillman and Christopher La Riche, Psychosocial judgements and perceptions of adolescents with acne vulgaris: A blinded, controlled comparison of adult and peer evaluations, BioPsychoSocial Medicine, 5, 1, (11), (2011 [doi.org]
Eyes
- Esotropia
© 2001-2016 Esotropia (inward turning of the eyes) Congenital Esotropia Infantile Esotropia Esotropia with Amblyopia Accommodative Esotropia Partially Accommodative Esotropia Esotropia can be divided into various categories each requiring a different [strabismus.org]
Esotropia (crossed eyes) needs to be treated early in life to prevent amblyopia. [allaboutvision.com]
It may be more effective in many subtypes of esotropia where surgery has been less reliable, including partially accommodative esotropia, esotropia associated with cerebral palsy, and thyroid eye disease. [ncbi.nlm.nih.gov]
- Diplopia
The goal of surgery was elimination of diplopia in primary and reading position. [ncbi.nlm.nih.gov]
Treatment is directed at restoring and maintaining ocular alignment, eliminating diplopia or visual confusion, enabling binocular vision, and restoring normal appearance. [bestpractice.bmj.com]
- Visual Impairment
Screening for visual impairment in children ages 1 to 5: recommendation statement. January 2011. [bestpractice.bmj.com]
At this point, the visual impairment will be termed "amblyopia," which is reduced visual acuity in the turned eye. [familyconnect.org]
In this dataset, for individuals with strabismus and a coexisting visual impairment, it has been the visual impairment that is recorded in the single field addressing vision. [onlinelibrary.wiley.com]
The Brain and Cerebral Visual Impairment 57. Perceptual aspects of Cerebral Visual Impairment and their Management Section 5: Selected Topics in Pediatic Ophthalmology 58. Ethics, morality and consent in Pediatric Ophthalmology 59. [elsevier.com]
‘Visual impairment caused by refractive error, amblyopia, strabismus, and astigmatism is a common condition among young children, affecting 5 to 10 percent of all preschoolers.’ [oxforddictionaries.com]
- Foreign Body Sensation
We compared the groups for inflammatory grades (individually for congestion, chemosis, discharge, foreign-body sensation, and drop intolerance and aggregated to a total inflammatory score (TIS), scar visibility (SV) at 1 m, and successful alignment (≤ [ncbi.nlm.nih.gov]
Headache, pulling sensation with eye movement and foreign body sensation in the eye are the most common complaints. These symptoms typically last only several days. [aapos.org]
In the month following the surgery, the patient complained of a foreign body sensation. A conjunctival cyst was visualized at the middle nasal side of the right eye, with severe conjunctival congestion (Figure 1(a)). [hindawi.com]
It usually presents a pink or purple-hued cystic mass under the conjunctiva, extending to the orbit with slight congestion, foreign body sensation and disturbance of eye movement [3]. [raredisorders.imedpub.com]
- Anisocoria
• (D) The left pupil shows minimal consensual response to light, with greater anisocoria. 45. Aneurysm site to cause IIIrd CN palsy 46. [slideshare.net]
Psychiatrical
- Visual Hallucination
Visual complaints and visual hallucinations in Parkinson’s disease. Parkinsonism Relat Disord (2014) 20(3):318–22. doi:10.1016/j.parkreldis.2013.12.009 PubMed Abstract | CrossRef Full Text | Google Scholar 58. [frontiersin.org]
Neurologic
- Confusion
Treatment is directed at restoring and maintaining ocular alignment, eliminating diplopia or visual confusion, enabling binocular vision, and restoring normal appearance. [bestpractice.bmj.com]
Visual Confusion. Strabismus in adults may also cause visual confusion, the perception of two different images superimposed onto the same space. [web.archive.org]
In three of the four cases, strabismus surgery was successfully performed to avoid diplopia/confusion. All three patients revealed normal retinal correspondence. [ncbi.nlm.nih.gov]
To avoid confusion, the brain usually will learn to ignore the image from the weaker eye. [youtube.com]
Strabismus and amblyopia In strabismus, each eye sends a different image to the brain, which is confusing. [news-medical.net]
- Paresis
Plagiocephaly has been reported to simulate ipsilateral superior oblique muscle paresis. We report a rare occurrence of contralateral superior oblique muscle overaction in an adult with anterior plagiocephaly. [ncbi.nlm.nih.gov]
Inferior oblique muscle paresis is a rare entity that can cause secondary overaction of the ipsilateral superior oblique muscle. [4] Horizontal rectus muscle dysfunction As a proposed cause or contributing factor in the development of an A-pattern strabismus [emedicine.medscape.com]
- Ataxia
Some of the main types of ataxia are described below. Read about the causes of ataxia for information about why these different types of ataxia develop. [nhs.uk]
La ataxia espinocerebelosa 36 (SCA36): «Ataxia da Costa da Morte». Neurología. 2017;32:386–393. Copyright © 2014. Sociedad Española de Neurología [elsevier.es]
Autosomal recessive spinocerebellar ataxia 15 (SCAR15) Autosomal recessive spinocerebellar ataxia 2 (SCAR2) Autosomal recessive spinocerebellar ataxia 14 (SCAR14) Autosomal recessive spinocerebellar ataxia 11 (SCAR11) Spinocerebellar ataxia with axonal [rarediseases.info.nih.gov]
COMPASSIONATE ALLOWANCE INFORMATION SPINOCEREBELLAR ATAXIA ALTERNATE NAMES SCA; Infantile-onset Spinocerebellar Ataxia; Autosomal Dominant Spinocerebellar Ataxia (ADSCA) DESCRIPTION Spinocerebellar Ataxia (SCA) refers to a group of genetic disorders characterized [secure.ssa.gov]
Name spinocerebellar ataxia 5 FlyBase ID FBhh0000064 Disease Ontology Term Parent Disease This report describes spinocerebellar ataxia 5 (SCA5), which is a subtype of spinocerebellar ataxia; SCA5 is inherited as an autosomal dominant. [flybase.org]
- Cerebellar Ataxia
[…] dysfunction, peripheral neuropathy, and progressive cerebellar ataxia. [frontiersin.org]
Homepage Rare diseases Search Search for a rare disease Spinocerebellar ataxia type 40 Disease definition Spinocerebellar ataxia type 40 (SCA40) is a very rare subtype of autosomal dominant cerebellar ataxia type 1, characterized by the adult-onset of [orpha.net]
SCA3 is a hereditary cerebellar ataxia that causes a degeneration of the cerebellum. There is damage created to the nerve cells and fibers that lead to the cerebellum’s damage. [lacaf.org]
These 2 unusual cases exhibit a gradually progressive cerebellar ataxia syndrome plus features specifically associated with SCA2 (ie, slowed saccades) and SCA10 (ie, seizures). [jamanetwork.com]
These patients presented with a form of cerebellar ataxia with slow saccadic eye movements4. [scielo.br]
Workup
At the preliminary level, a detailed physical examination of the eye will be carried out. This will be followed by various eye tests which would provide information about the extent of misalignment of the eyes. These tests include retinal exam, Hirschberg test, visual acuity, corneal light reflex and standard ophthalmic examination. In addition, neurological examination would also be performed to assess the neurological functioning [7].
Treatment
Strabismus can be treated in several ways which include the following:
- Eye glasses or patch: Children with strabismus are prescribed eye glasses if required. Also, it is necessary to treat amblyopia at first and therefore a patch is recommended which covers the healthy eye and forces the child to see with the weak eye.
- Eye muscle surgery: When other treatment methods fail, eye surgery is usually the last resort. Through this surgery, the muscles of the eye will be made stronger or weaker depending on the condition. However, eye surgery would still require the child to wear glasses. It is also recommended that sooner the surgery is done better will be the outcome [8].
- Eye exercises are recommended for both children and adults with strabismus. This helps the eye muscles to strengthen and keep the eyes straight.
- Botulinum toxin therapy was approved by the FDA way back in the year 1989 for treatment of strabismus in children over 12 years and adults. Children affected by infantile estropia benefit from this method. In this procedure, the toxin is injected in the stronger muscles in order to temporarily paralyze it [9] [10].
Prognosis
The prognosis of the condition post treatment is usually favorable. However, children and adults would continue to have vision problems. This may cause reading problems in children and adults would face difficulty while driving. Delay in treatment may lead to permanent vision loss in the weak eye. Follow up treatment and constant monitoring is a must as chances of recurrence of strabismus is high.
Etiology
Strabismus is a common phenomenon both in children and adults. Failure of the eye muscles to work in coordination causes both the eyes to look in two different directions. Certain underlying disease conditions which can also lead to strabismus in children include cerebral palsy, Apert syndrome, retinoblastoma, congenital rubella, Noonan syndrome, Prader-Willi syndrome, traumatic brain injury, incontinentia iigmenti syndrome, trisomy 18 and development of hemangioma near the eye during infancy.
Various diseases associated with strabismus in adults consist of diabetes, botulism, stroke, eye injury, vision loss due to eye injury or disease, Guillain-Barré syndrome and shellfish poisoning. In addition to the above mentioned factors, heredity is also known to be a strong risk factor for development of strabismus [2].
Epidemiology
It has been estimated that 4% of individuals in United States develop strabismus. Of the several forms of strabismus, estropia usually develops in the first decade of life [3]. It has also been reported that about 1/3rd of children with strabismus are at an increased risk of developing amblyopia.
Pathophysiology
Under normal conditions, the normal movement and alignment of human eye is governed by 6 muscles that work as a team. These ocular muscles help the eye to focus on the same object at same time. However, in instances when the muscles do not work appropriately it causes both the eye to look differently at two different objects.
As a result of this phenomenon, the brain receives information about 2 different objects. In children, the brain tends to ignore the information sent from the weak eye. In such situations, if strabismus is not promptly treated, then the brain will forever ignore information from the weak eye and as a result that eye will have poor vision. Such a condition is termed as amblyopia [4] [5].
Prevention
So far there are no known methods of preventing strabismus. Its associated complications can however be prevented with early initiation of treatment.
Summary
When the eyes align inappropriately with each other, they are unable to focus together on the same point at the same time. Strabismus gravely affects the binocular vision and in turn affects the depth perception as well. A prompt treatment regime is required to correct the condition so that maximum vision acuity can be retained. Strabismus can be classified into 4 different types, depending on directional prefixes. These include estropia, exotropia, hypotropia and hypertropia [1].
Patient Information
Definition
Strabismus is an eye disorder characterized by inappropriate alignment of the eyes which does not allow both the eyes to focus at the same object at same time. An estimated 4% US population develops this eye disorder. Early initiation of treatment can help in preventing onset of complications.
Cause
A total of 6 eye muscles work in coordination to provide appropriate alignment to the eyes. When the muscles do not work as a team, then strabismus develops. In addition, certain underlying disease conditions such as diabetes, eye injury, stroke, eye disease, restinoblastoma, Noonan syndrome, Apert syndrome, congenital rubella, trisomy 18, cerebral palsy and Prader-Willi syndrome can also predispose children and adults to develop such a condition.
Symptoms
Crossed eyes and inappropriate eye alignment are the major symptoms experienced. In addition, individuals also experience poor vision, loss of vision, loss of depth perception and inability to move both eyes together.
Diagnosis
Diagnosis of strabismus begins with preliminary physical examination of the eyes. In addition, neurological examination is also carried out to assess the neurological functioning. Following this various eyes tests such as corneal light reflex, retinal exam, cover/uncover test, visual acuity and standard ophthalmic test are also performed.
Treatment
Treatment of strabismus includes prescribing eye glasses and patches to the children. In case, when these do not work then eye surgery is recommended. In addition to these methods, botulinum toxin injection is also employed for treating strabismus.
References
- Harley RD. Pediatric Ophthalmology, WB Saunders Company, Philadelphia 1983. p.143.
- Aurell E, Norrsell K. A longitudinal study of children with a family history of strabismus: factors determining the incidence of strabismus. Br J Ophthalmol 1990; 74:589.
- Greenberg AE, Mohney BG, Diehl NN, Burke JP. Incidence and types of childhood esotropia: a population-based study. Ophthalmology 2007; 114:170.
- Archer SM, Sondhi N, Helveston EM. Strabismus in infancy. Ophthalmology 1989; 96:133.
- Mohney BG. Common forms of childhood esotropia. Ophthalmology. Apr 2001;108(4):805-9.
- The eyes. In: Pediatric diagnosis: Interpretation of symptoms and signs in children and adolescents, 6th, Green M (Ed), WB Saunders Company, Philadelphia 1998. p.15.
- Committee on Practice and Ambulatory Medicine, Section on Ophthalmology. American Association of Certified Orthoptists, American Association for Pediatric Ophthalmology and Strabismus, American Academy of Ophthalmology. Eye examination in infants, children, and young adults by pediatricians. Pediatrics 2003; 111:902.
- Ho TH, Lin MC, Sheu SJ. Surgical treatment of acquired esotropia in patients with high myopia. J Chin Med Assoc. Aug 2012;75(8):416-9.
- Birch E, Stager D, Wright K, Beck R. The natural history of infantile esotropia during the first six months of life. Pediatric Eye Disease Investigator Group. J AAPOS 1998; 2:325.
- Fukai S, Arai N, Hayakawa T, Kimura H. Studies on the botulinum therapy for esotropia improvement of retinal correspondence. Nippon Ganka Gakkai Zasshi. Jun 1993;97(6):757-62.