Strabismus and Neuro-Ophthalmology

Strabismus is the term used when the two eyes are misaligned. Strabismus can be congenital or acquired. Acquired strabismus is typically caused by a neurologic or muscular abnormality whereas congenital strabismus is something people are born with or starts at an early age. Congenital strabismus is typically comitant, meaning that the misalignment between the eyes is the same in all directions of eye movement and the eyes are able to move fully in all directions. Acquired strabismus is typically noncomitant, meaning that the misalignment is different in certain directions of eye movements and/or eye movements are not full/complete in both eyes.

People can be born with their eyes perfectly straight or misaligned. If misalignment of the eyes is present in a child (typically under the age of 7 but up to the age of 12), they will not see double like an adult will because their visual system has not yet developed. Many people are also born with their eyes appearing straight but when vision is relaxed, there is a tendency for the eyes to drift out of alignment. In these people, the majority of the time the brain and eyes work together to keep the eyes straight and to keep an image single. Over time or with injury or illness, this ability to keep the eyes straight can break down and double vision can develop. This is called decompensated congenital strabismus. Strabismus in children should be treated to help prevent “lazy eye” known as amblyopia. Strabismus in adults can be fixed with prism or surgically. Eye contact is one of a human’s major methods of communication, so aligning the eyes can greatly improve not only vision and depth perception but also a person’s ability to communicate, all of which are important for normal function and improved quality of life.

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