Strabismus: Causes, Symptoms and Treatment

Learn how Orbis is improving access to eye care to treat strabismus in communities around the world. 

Movement of the eyes is controlled by six muscles attached to each eye. These muscles allow the eyes to move in all directions. Both eyes should always move together so that even though we have two eyes, we see one thing at a time.

If one of the muscles is weak, the eye cannot move properly and the two eyes cannot move together - resulting in strabismus. The condition can occur in one eye or both eyes and often occurs before the age of three years.

It can be present all the time, or just sometimes, especially when a child is tired. It can also be a symptom of other eye problems, such as retinopathy of prematurity or congenital cataract.

If not treated in time, the weaker eye will not develop good vision and become a ‘lazy eye’. This is called amblyopia. Over time, the brain will learn to ignore the image from the weaker eye which can lead to legal blindness.

Children with strabismus often develop poor self-image and may have emotional problems. 

Our research has shown that children with uncorrected strabismus are more likely to have depression and anxiety due to social and educational disruptions.

Below, hear Maiyan’s story and how Orbis and our partners saved her sight and the threat of bullying at school.

Most often, the causes of strabismus are idiopathic meaning there is no known cause.

However, strabismus can develop with other refractive errors, where there are difficulties with the focusing power of the eye as well as conditions such as cataracts, retinopathy of prematurity and optic nerve conditions.
 

Other risk factors of strabismus include:

• Family history
• Prematurity
• Low birth weight
• Cerebral Palsy
• Down’s syndrome
• Brown’s syndrome
• Duane’s retraction syndrome
• Eye injury

Signs and symptoms of strabismus include:

• Inward (esotropia — eye turns inward, towards the nose)
• Outward (exotropia — eye turns outward, away from the nose)
• Upward (hypertropia)
• Downward (hypotropia)
• Squinting or closing one eye in bright sunlight
• Double/blurred vision
• Tilting or turning the head to look at an object
• Bumping into objects due to poor vision

Treatment for strabismus should begin as soon as possible. The younger the child is when diagnosed and treatment starts, the better the chances are of correcting. Follow-up examinations once treatment begins are vital to ensure the eyes stay aligned. Once the type of squint is diagnosed, the following steps can be taken to help improve the level of vision.

Occlusion Therapy (patching) and Eye Drops

In very mild cases of squint, occlusion therapy (patching of the good eye) may help build up the pathway between the lazy eye and the brain - giving the weaker eye a chance to catch up. The patch can be worn for a few hours of the day or for the whole day.

Atropine eye drops which blur vision in the good eye work in the same way to strengthen vision in the lazy eye.

Eyeglasses

Spectacles to straighten the eyes may be prescribed in mild cases of strabismus.

Vision Therapy

Vision Therapy (eye exercises) can also be used to treat certain kinds of strabismus.

Eye surgery

If the other treatments aren't successful, a simple surgery to correct strabismus involves repositioning the eye muscles to realign the eyes and restore normal vision. The surgery requires general anesthesia and stitches are used to attach the muscles in their new positions.

In many remote communities around the world, infants and children remain visually impaired or blind from strabismus due to a lack of access to quality eye care services.

Coupled with this, government insurance in some places does not cover highly-effective medical and surgical treatments for strabismus, classifying it erroneously as a cosmetic condition.

This is where we step in. A large focus of our work has been treating cases of childhood blindness and our programs around the world have not only treated thousands of children but have also successfully changed government policies to improve insurance outcomes so infants and children with strabismus can get the eye care they deserve.

By using our amazing network of partners, supporters, staff, and world-leading volunteers, we empower local communities with the skills and resources to improve eye care for patients with strabismus. Below, read stories about some of the children we've been able to help, thanks to the incredible support of our wonderful partners and donors.

At Orbis, we're implementing a comprehensive approach to improve eye care for people impacted by strabismus. 

Training: We provide advanced training and mentorship to eye care teams in nearly every country in the world, empowering them to deliver sight-saving care where the need is greatest. Our specialist training is delivered in partnership with local hospitals, public health agencies and governments. It takes place on board our incredible Flying Eye Hospital, through our online mentoring platform, Cybersight, and through our long-term country programs.

Technology: Through innovative technology like our award-winning telemedicine platform Cybersight, artificial intelligence diagnostic technology, virtual reality training, and the world’s first and only Flying Eye Hospital, we're revolutionizing ophthalmic training for eye care professionals and treatment for patients around the world.

Treatment and prevention: Through our long-term country programs we provide equitable access to quality eye care that transforms lives and communities. Orbis puts eye care within reach through programs that serve communities where they are. To reach the most underserved populations, quality care must be not only available, but also easily accessible.

Teamwork: Through support from donors, corporate sponsors, employees, governments, and a team of more than 400 world-renowned medical volunteers, we work in collaboration with local partners to improve the quality and availability of eye care, ensuring our impact endures long term and becomes self-sustaining.