Main
- Squint — the eyes lose their coordinated work, the brain stops taking into account the signal from the deviated eye, and vision in it weakens.
- Causes — heredity, uncorrected long-sightedness or short-sightedness, head and eye injuries, infections, stress, vascular disorders.
- Symptoms — deviation of the eye, double vision, tiredness when reading, tilting or turning of the head, squinting in the light, difficulties with depth.
- Diagnosis — the ophthalmologist checks visual acuity, eye mobility and the angle of squint, examines the fundus, and if suspected refers to a neurologist.
- Treatment — selection of glasses or lenses, special exercises, hardware techniques, surgery on the eye muscles in case of pronounced deviation, regular monitoring.
What is strabismus
Strabismus is a condition in which the eyes look in different directions and lose their coordinated work. It can be constant or appear from time to time, and it occurs in children and in adults.
What happens in the body
Strabismus occurs when the muscles that control eye movement stop acting in a coordinated way. Each eye is controlled by several muscles that pull it in different directions. The brain receives two pictures from the eyes and combines them into a single three-dimensional image. If one eye deviates to the side, the images diverge and overlap each other. To remove double vision, the brain over time stops taking into account the signal from the deviated eye. Because of this, vision in it gradually weakens, and the ability to see with both eyes together is lost. The deviation can be noticed by the way one eye looks straight while the other is shifted towards the nose, towards the temple, upwards or downwards. Parents should take a closer look if a child squints or tilts their head to examine an object.
What causes it to develop
- Hereditary predisposition: if close relatives had strabismus, the risk in a child is higher, so it is worth telling the doctor about such a family history.
- Uncorrected long-sightedness or short-sightedness: when glasses are not prescribed, the eye strains more and the muscles lose coordination.
- Head or eye injury: the damage affects the nerves and muscles responsible for the joint movement of the eyes.
- Infectious and neurological diseases: they disrupt the transmission of signals from the brain to the eye muscles and change their function.
- Stress and severe visual strain: prolonged strain on the eyes weakens control over their position.
- Vascular and endocrine disorders in adults: they affect the nourishment of the nerves and muscles, so the deviation can appear in adulthood.
Who encounters this more often
Strabismus is most often detected in children, but it also occurs in adults. In children, the deviation is usually associated with heredity or with uncorrected long-sightedness that was not noticed in time. A child does not always complain about their vision, because they get used to seeing this way from an early age. Parents may notice that they tilt or turn their head, squint one eye, or get tired when reading. In adults, the deviation often appears after a head or eye injury, against the background of infectious and neurological diseases. It is also caused by vascular and endocrine disorders, stress and prolonged visual strain. In adulthood, this condition is tolerated more severely, because the brain has already got used to the coordinated work of both eyes. If relatives notice that the gaze has become asymmetrical, it is reasonable not to postpone a visit to an ophthalmologist.
What symptoms can occur?
Strabismus manifests as a deviation of one or both eyes from the general direction of gaze, and it can be noticed at different ages. Below is a description of which signs indicate such a condition and in which cases help is needed without delay.
How it is noticed at the very beginning
Parents often notice strabismus in a child by the fact that he squints, tilts his head or covers one eye to see better. An adult may himself discover that one eye looks straight while the other deviates to the side. Sometimes the first signal is double vision, which makes it difficult to read or work at a computer. Rapid fatigue during visual strain is also often an early sign. Squinting one eye in bright light and turning the head when looking help a person to bring the picture together. In children, difficulties with perceiving the depth of space are added to this, which makes it harder for them to judge distance. Such manifestations are easy to attribute to fatigue or poor lighting, so if they recur, the person should be shown to an ophthalmologist.
Signs that occur most often
- Eye deviation: one eye looks straight while the other drifts to the side, and this is noticeable from the outside during conversation or when looking into the distance.
- Double vision: the picture doubles, which makes it difficult to read text and distinguish objects at a distance.
- Fatigue during strain: the eyes tire quickly when reading or working at a computer, and there is a desire to take a break and rest.
- Tilting or turning of the head: a person involuntarily changes the position of the head when looking so that the image becomes clearer.
- Squinting in the light: one eye squints in bright lighting, which helps to reduce discomfort and blurriness.
- Difficulties with depth: in children, the perception of the depth of space suffers, so it is harder for them to judge the distance to objects and steps.
When to seek help urgently
Examinations and tests
Examination for strabismus begins with an ophthalmologist's assessment and a check of how the eyes work together. Additional methods help to clarify the cause and rule out neurological diseases.
How the examination begins
The first step is an appointment with an ophthalmologist, who assesses the condition of the eyes and their optical media. The specialist checks visual acuity separately with and without correction to understand how each eye sees the image. Then they assess the mobility of the eyeballs and measure the angle of strabismus, observing the position of the eyes when looking in different directions. Examination of the fundus and the optical media of the eye allows the internal structures to be seen and changes affecting vision to be ruled out. Computerised refraction diagnostics clarifies how the eye refracts light rays and whether there are deviations in the optical system. If the doctor suspects a neurological cause, they refer the patient for a consultation with a neurologist for a more in-depth assessment of the condition. It is worth going through all the stages consistently with one specialist so that the picture is complete and the tests do not have to be repeated.
What is prescribed and what it shows
What is worth preparing for the appointment
- Ophthalmologist's reports: bring all previous conclusions so that the doctor can see how the condition has changed over time.
- Vision test results: data on visual acuity with and without correction will be useful if such measurements have already been taken.
- Neurologist's conclusions: if you are under the care of this specialist, their notes will help to assess the possible link between strabismus and the nervous system.
- Observations of close ones: write down in which position the deviation of the eyes is noticeable and how often it happens.
- List of questions: formulate in advance what you want to clarify with the doctor so that you do not forget anything during the conversation.
Which doctor should I see?
In strabismus, help is provided by an ophthalmologist and a paediatrician, and treatment is selected individually. Below — who to see, what happens at the appointment and what the care consists of.
Which specialist manages this condition
Strabismus is managed by an ophthalmologist, and in children care often goes together with a paediatrician. The ophthalmologist examines the eyes, assesses the position of the eyeballs and checks how consistently they work together. The paediatrician looks at the child's general condition and helps to understand whether there are other causes for changes in vision. If there is no specialised ophthalmologist nearby, start with the paediatrician: they will examine and advise where to go next. At the first appointment, the doctor clarifies when the strabismus appeared and how it manifests in everyday life. The specialist checks the vision of each eye separately, because one eye may see worse than the other. Then they explain whether correction with glasses or lenses is needed and what steps lie ahead. Do not postpone the visit: the earlier observation is started, the clearer the plan of action.
What the treatment consists of
- Selection of glasses or lenses: vision correction helps the eyes work more consistently and reduces strain during everyday tasks.
- Special exercises: training for coordinated eye work is performed regularly, and the doctor selects it for the specific case.
- Hardware treatment: methods prescribed by the doctor are used as a supplement and require repeat visits for monitoring.
- Surgery on the eye muscles: surgical intervention is discussed in pronounced strabismus if other methods have not given the needed effect.
- Regular monitoring: examinations by an ophthalmologist allow changes to be noticed in time and the chosen approach to be adjusted.
What depends on the patient themselves
Regular monitoring by an ophthalmologist is the part of the result that largely rests on the patient themselves and their loved ones. If visits are missed, the doctor does not see how the position of the eyes changes and cannot restructure the care in time. Home exercises give results only with constant performance, not from time to time. Glasses or lenses must be worn as recommended, otherwise the correction does not work to the needed extent. Parents should note down when the eye deviation is noticeable and in which situations it occurs. Such observations help the doctor assess the dynamics more accurately and choose the next step. If something in the recommendations is unclear, it is better to ask again at the appointment than to guess on your own. Calm and consistent following of the doctor's plan noticeably eases all further work.
What helps prevent an exacerbation?
Prevention of strabismus does not come down to a single action: it is made up of everyday habits, reasonable visual load and regular examinations by an ophthalmologist. Below is what actually depends on the person themselves and how this reduces the risk of exacerbation.
What is changed in habits
The visual regime under load is the first thing that can be changed without a doctor's help. Prolonged work with a screen or a book at a close distance forces the eyes to converge their gaze towards the centre for long periods, and the muscles hardly rest at all. It is useful to take pauses during which the gaze is shifted to distant objects — this lets the muscles relax. Light when reading and working should fall on the page or screen, not into the eyes and not create glare. Timely correction of long-sightedness and short-sightedness is important because an uncorrected defect forces the eye to strain more than usual. Protecting the head and eyes from injuries reduces the risk of damage that can disrupt the work of the eye muscles and nerves. Paying careful attention to complaints of double vision or eye fatigue allows the problem to be noticed before it becomes established. If such complaints appear, it is reasonable not to postpone a visit to the ophthalmologist rather than putting them down to ordinary overwork.
What should be kept under control
- Regular preventive examinations by an ophthalmologist: routine vision checks in children and adults, especially with a hereditary predisposition, help to notice a deviation before persistent complaints appear.
- Correction of long-sightedness and short-sightedness: the selected glasses or other means of correction must correspond to the current state of the eyes, so they are reviewed when vision changes.
- Visual regime under load: alternating near work with rest and shifting the gaze into the distance reduces the strain on the eye muscles during the day.
- Protecting the head and eyes from injuries: caution at home, at work and during sports reduces the risk of damage that can affect the position of the eyes.
- Complaints of double vision or eye fatigue: such sensations should be noted and discussed at an appointment, since they may indicate a change in the load on the eyes.
- Hereditary predisposition: if close relatives had strabismus, examinations are carried out more carefully and the scheduled appointment dates are not missed.
How often to see a doctor
Regular monitoring by an ophthalmologist is needed even when vision seems good and there are no complaints. Strabismus can develop gradually, and at an early stage a person does not always notice that one eye has begun to deviate or that the load is being distributed unevenly. Routine examinations allow the position of the eyes, visual acuity and the work of the eye muscles to be assessed over time, rather than from a single random measurement. For children such checks are especially important, since the visual system continues to form and a deviation noticed in time is easier to correct. For adults, examinations help to track changes related to age, past injuries or prolonged visual load. If double vision, rapid eye fatigue or a feeling that the image doubles towards the evening appear, the visit is not postponed until the next scheduled date. Missed examinations do not allow the specialist to see how the condition changes over time, so it is better not to shift the schedule of visits at one's own discretion.
What is worth remembering
Strabismus is a condition in which the eyes do not look at the same point, and a calm, consistent approach helps to make sense of it. Below is what is worth keeping in mind after becoming familiar with the topic.
Key takeaways
Strabismus is not merely a cosmetic defect: in this condition the brain receives different images from the eyes and over time may begin to suppress the picture from one of them. Childhood is especially sensitive to this, when the visual system is still developing, so delay can entrench the disorder for a long time. Strabismus can be noticed by deviation of the eye, by tilting or turning of the head, by complaints of fatigue and double vision during visual work. On its own, such a condition does not resolve and is not corrected by randomly selected glasses. The decision on whether observation or intervention is needed is made by an ophthalmologist after examination, not on the basis of external impression. If the visit is postponed, restoring binocular vision can be more difficult, and sometimes impossible. A reasonable step is not to wait until the deviation becomes constant and not to try to correct it on one's own.
