About Strabismus and Motility.

Strabismus is a condition when your two eyes are not pointing together at the same place. One eye may be turned in, out, up, or down compared to the other. When the two eyes are not aligned, the condition is called "strabismus", and this eye muscle or alignment condition is called a motility disturbance.

What Causes Strabismus and Ocular Motility Disturbances?

Some people are born with their eye not aligned correctly. This is called congenital. If the eyes are pointed toward each other, or crossed, it is called congenital esotropia. This is quite common problem and is usually fixed with one or more operations to correct the alignment or motility problem. More on the surgery later. These kids usually develop this condition during the first few months of age.

People born with their eye pointed out relative to each other have congenital exotropia. This is a quite uncommon eye condition.

Accomodative Esptropia - Crossing of Eyes Due to Farsightedness

Some people develop crossing of the eyes because they are very farsighted or "hyperopic". That means that their eyes are relatively short, they need plus or converging eyeglasses, and that the closer things are to them, the more those images seem blurred.

People with hyperopic eyes that cross have a strabismus condition we call accommodative esotropia. We measure these people carefully to find out what strength of eyeglasses they need ( a refraction) and then order glasses with this refractive correction, or eyeglass prescription. Usually, their eyes will straighten out when they put the new glasses on. This condition is more common for kids aged 2 1/2 to 3 years or older.

If the eyeglasses control the problem completely, then no other treatment is needed. Sometimes eyedrop medicine ( a medicine called physostigmine) can be used to keep the eyes straight without the need for glasses. Sometimes, eyeglasses are not enough to keep the eyes straight, and eye muscle surgery is the only way to completely correct the strabismus.

Cranial Nerve Damage - Cranial Nerve Palsey

Some people receive injuries to their heads or develop medical conditions such as diabetes or high blood pressure, which can damage the special nerves leading from the brain to the eye muscles. There are three key nerves from the brainstem involved, called "Cranial Nerves", that go to specific eye muscles, which control all eye muscle movement.

When these are damaged by injury, infection, or a medical condition like diabetes or hypertension, then the nerve may not work correctly and the eye may not align as it should leading to a a condion called cranial nerve palsey. When this happens, the eye may drift up, down, in, or out depending on which nerve and which muscle is affected.

Special glasses with "prisms" (wedges of glass on one side of the eyeglass) can sometimes bend the misalignment of the eye around so that the eye sees straight. Sometimes the misalignment is so severe or persists for such a long time that surgery is the only way to correct the problem.

People may develop misalignments of their eyes because of medical condtions such as thyroid disfunction. When this happens, the misalignment may be fixed with prisms in the eyeglasses or eye muscle (strabismus) surgery.

How Does the Doctor Make a Strabismus Diagnosis?

Some eye doctors are specially trained in eye muscle problems. They are called specialists in "pediatric ophthalmology" (because this is most frequently a kids’ problem) and "strabismus" Dr. Kindermann received this specialty training at the Wills Eye Hospital under Dr. Robison Harley and Dr. Joseph Calhoun, two world famous pediatric ophthalmologists.

Eye doctors who are trained to evaluate problems of eye alignment (strabismus) can examine your eyes and perform special tests in the office to evaluate and diagnose an eye muscle condition. They can then recommend a course of treatment that may involve eye patching, eye medicines, eyeglasses, eye muscle surgery, or other possible options to correct the problem.

What is the Goal of Strabismus Treatment?

The first and most important goal is to make sure that vision develops to its potential, and that every eye sees as well as possible. This is especially true with children where the visual system is still developing and an eye that does not develop correctly may be partially or completely blinded (a condition called amblyopia). With children who have developed amblyopia, the first goal is to overcome the ambylopia, usually with patching to allow a weaker eye to catch up to the stronger seeing eye. After that, a strabismus problem has the best chance of successful correction.

In adults with a misalignment problem, finding the cause of the strabismus is the first goal. If the problem can be fixed by correcting the medical problem. For example, people with a condition called Myasthenia gravis, if it is possible to fix the misalignment by treating the strabismus, then that is the first goal. If the diagnoses explains the cause of the problem, such as diabetes, but the strabismus will not go away even after the strabismus is treated, then treatment with eyeglasses or surgery may be the permanent cure. However, patching or prisms may be used to minimize double vision that would otherwise disable the patient.

At Kindermann Eye Associates, we are strabismus and motility specialists. Contact us for your examination.

(856) 667-3937

Kindermann Eye Associates
3001 Chapel Avenue, Suite 200
Cherry Hill, New Jersey 08002