Makindo Medical Notes

Children with a lazy eye or strabismus (deviation of the eye, usually inward) that persists beyond 3 months need an ophthalmologic referral.

About

• Strabismus, more commonly known as a squint
• Person cannot align both eyes simultaneously under normal conditions.
• One or both of the eyes may turn in, out, up or down
• Without treatment there is blindness (amblyopia) in the affected eye

Aetiology

• Visual system is still developing after birth until the age of 8 years
• Development requires congruent images at both retinas
• If not the brain cannot fuse the two different images
• The brain suppresses the bad eye and optic pathways do not develop

Risks

• Family history: People with parents or siblings who have strabismus are more likely to develop it.
• Refractive error: Uncorrected farsightedness (hyperopia) may develop strabismus because of the additional eye focusing they must do to keep objects clear.
• Medical conditions: Down syndrome and cerebral palsy or who have suffered a stroke or head injury.

Causes

Clinical

• Cover up the good eye and encourage the use of the Lazy eye
• Visual screening must be done in paediatric patients
• Worse if person is tired, ill, or has done a lot of reading or close work

Management

• An optometrist will ask the patient or parent about any current symptoms and will measure visual acuity in each eye to assess how much vision is being affected. Assess refraction to determine the appropriate lens power you need to compensate for any refractive error (nearsightedness, farsightedness or astigmatism). Alignment and focusing testing. Examination of eye health. Using various testing procedures, your optometrist will observe the internal and external structures of your eyes to rule out any eye disease that may be contributing to strabismus.
• Eyeglasses or contact lenses. This may be the only treatment needed for some patients and corrects refraction issues.
• Prism lenses. These special lenses have a prescription for prism power in them. The prisms alter the light entering the eye and reduce how much turning the eye must do to view objects.
• Vision therapy. a structured program of visual activities to improve eye coordination and eye focusing. Vision therapy trains the eyes and brain to work together more effectively. These eye exercises can help problems with eye movement, eye focusing and eye teaming and reinforce the eye-brain connection.
• Eye muscle surgery. Surgery can change the length or position of the muscles around the eye so they appear straight. Often, people who have eye muscle surgery will also need vision therapy to improve eye coordination and to keep the eyes from becoming misaligned again.

References