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Paediatric eye diseases & Strabismus (squint)

Amblyopia
Amblyopia, or lazy eye, is the most common condition causing poor vision in children. It arises as a result of suppression of the vision from the poorly focused eye (eye with refractive errors), or eye with misalignment(cross eye, or outward turning of the eye) by the developing brain in children less than 7 - 8 years of age. If seen and treated early, almost all of those children suffering from amblyopia will regain normal vision. On the other hand, if left untreated, or if there is a delay in getting treatment, the child will be left with permanent visual impairment in the amblyopic eye and will lose the ability to see 3 dimensionally or lose his or her “3D” vision (stereopsis).

As a result, those children will have limitations in their future career choices. We recommend you have your child checked if you have any concerns in this regard as soon as possible

Causes of Amblyopia
The most common causes for amblyopia are focus errors in the eye, such as long-sightedness (Hypermetropia), focus difference between two eyes (Anisometropia) and rarely near-sightedness (Myopia).
The next most common cause of amblyopia is Strabismus (squint). This can be “cross eye” (convergent strabismus), or outward turning of eye (divergent strabismus).
Other causes include congenital cataract (opacity of the lens inside the eye) or drooping eyelids (ptosis).
 

Treatment of amblyopia
The correct treatment depends on the exact cause of amblyopia, and this can only be identified after a thorough examination of the eye. In many children, simply by correcting their eye focus with the aid of glasses will improve their vision. Some will need to use eye patching to force the child to use the poor sighted eye (amblyopic eye) and by doing so the vision in the amblyopic eye will be improved. There are other options for treating amblyopia and Eye Doctors will guide you and your child through the entire process of treatment based on your child’s specific ocular condition.

Strabismus (squint) in children
Strabismus, or squint is the misalignment of the eyes. It can be convergent (crossed eye), or divergent (outward turning of eye). One eye can be higher than the other eye (Hypertropia), or lower than the other eye (Hypotropia). About half of those children with cross-eye’s are due to uncorrected long-sightedness. Wearing appropriate glasses will not only improve their vision but also correct their cross-eye condition. The other half of children with cross eye’s and almost all children with constant out-turning of the eye will need eye muscle surgery to correct their squint.

Accommodative Esotropia without glasses	and with glasses(right)

Accommodative Esotropia without glasses (left)
and with glasses (right)

Some times, a child with life threatening tumors in the eye or in the brain can first present with squint. So a sudden onset of a squint requires urgent investigation.
Research and clinical trials involved in straightening the eyes of children have shown their is not only the advantage of improved appearance, but more importantly improved ability for the child to see “3 D” vision and in their overall motor skills.

Before surgery Day 1 after surgery

Strabismus in adults
Common causes of strabismus (squint) in adults can be due to trauma to the eye muscle or bony structure around the eyeball, paralysis of the nerves innervating the muscle(s) and sometimes due to thyroid diseases. A small number of adults have residual strabismus left uncorrected, or unsuccessfully corrected from their childhood. Like childhood strabismus, adult strabismus can also cause significant functional impairments and is therefore not merely a cosmetic concern. For example, an adult with cross-eye’s can only see half of the visual field usually seen by a person without cross eye’s. An adult with strabismus is often severely disabled because the person will have “double vision”. Because of the double vision, the person will not be able to drive or do his/her normal duties at work.
Treatment for adult strabismus often needs surgery to align the eyes properly. This will get ride of the double vision, enlarge the visual field and return the appearance back to normal. Special surgical techniques performed by Eye Doctors such as ‘adjustable suture’ strabismus surgery increase the success rate of adult strabismus surgery well above 95%.

Strabismus Surgery Adjustable suture eye muscle surgery

Nystagmus (jiggling of the eyes) & abnormal head posture
Nystagmus, or jiggling of the eyes can occur from poor vision in childhood, or as a result of albinism (lack of pigmentation in the skin) and other neurological conditions. In these patients, turning their head to certain directions minimizes the intensity of the jiggling of the eyes and their vision often improves. Eye Doctors offers special eye muscle surgery that can lead to straightened head posture, reduced jiggling of the eyes and improved vision.