Treatment of Strabismus: Misaligned eyes need early detection and correction

By Nick Rees

Crossed eyes, wall eyes, wandering eyes and deviating eyes are all terms that are commonly used to describe strabismus.

"Strabismus is a misalignment of the eyes," Dr. Deena Leonard, MD, selected as a Chicago Top Doctor by TopTierMD as a top rated ophthalmologist in Chicago, says. "The eyes could turn inward, deviate outward or deviate vertically. This is common to about five percent of the general population.

"Imagine covering one of your eyes and walking around - you don't have depth perception. That can impair kids mentally and impair their motor skills. There is lots and lots of anecdotal evidence for kids whose development soars within a day of getting their eyes straightened. For kids who are not hitting developmental milestones, they take off once their eyes are straightened. It's quite dramatic and rewarding."

Strabismus can be diagnosed in several ways. The cover test may be used during eye examinations. A strabismic eye will fixate on a specific object after the "straight" eye is covered. If the "straight" eye is tested, the fixation will not change.

Another common test is the Hirschberg test, which consists of shining a flashlight into a patient's eye. When looking at the light, a reflection will be seen on the surface of the pupil. In properly aligned eyes, the reflection will be visible in the same spot for each eye. If it is not, then the eyes aren't properly aligned.

After a strabismus diagnoses, Dr. Leonard says, the first step to correcting the problem is to diagnose the underlying cause.

"Some children's eyes misalign because one or both of the eyes are unhealthy or one or both of the eyes are out of focus, in which case glasses may play a role in treatment," Dr. Leonard says. "For another group of children with out of focus eyes, we prescribe glasses. For many of those children, wearing glasses is enough to keep the eyes straight.

"For other children, it's purely a muscle problem, in which case we must ascertain if the eye is weak visually. The stronger eye will be patched and, once the vision is equal, we proceed with strabismus surgery."

Dr. Leonard says that approximately 40 percent of the strabismus cases her practice sees require surgery.

Surgery on a strabismic eye does not change the eyes vision. Instead, the goal is to align the eyes by lengthening, shortening or changing the position of eye muscles.

"There are other alternatives, like a botox injection in one of the muscles," Dr. Leonard says.

Without surgery or another form of treatment, Dr. Leonard warns, irreversible vision loss is possible in the long term.

"I get kids coming in that are told their strabismus will go away," Dr. Leonard says. "It's really important for parents to understand that it's really almost never okay for eyes to be misaligned. It can be an indication of a severe underlying vision abnormality or health abnormality like retinal blastoma, which is a potential lethal eye tumor that commonly presents as strabismus.

"It's also important to know that many kids have eyes that misalign in the first few months of life because they're learning how to see and use their eyes together. If there's a persistent misalignment beyond six months of age, even if it's intermittent, it needs to be looked at."

Dr. Deena Leonard, MD of Premier Eye Care and Surgery was selected in 2010 by TopTierMD as a Chicago Top Doctor - Dr. Deena Leonard was named a Top Rated Chicago Chicago Pediatric Ophthalmologist specializing in Treatment of Adult Strabismus (cross-eye), Amblyopia (lazy eye) and blocked tear ducts.  She practices in Barrington, IL and Buffalo Grove, IL.