A Little Pirate
Mrs. Apple noticed that the eyes of her baby Chloe often did not work together. She had read in a book how babies sometimes appear cross-eyed or how it seems one eye is looking off in another direction from the other, which can be normal for a very young baby. But when Chloe was about four months old, Mrs. Apple became worried. Chloe's left eye seemed to be looking at her nose when Mrs. Apple moved her face close, and the right eye seemed to be looking straight ahead. Mrs. Apple took the baby to an ophthalmologist for an eye exam and was told that Chloe likely had strabismus.
It is usually a parent who first notices the signs of strabismus when children are infants or preschoolers. The children are too young to complain about double or poor vision. If Mrs. Apple had not taken action because of her worries, the strabismus might have developed into amblyopia, leaving Chloe without vision in the crossed eye. Without treatment, amblyopia may become permanent.
The ophthalmologist recommended that Chloe wear an eye patch over her normal eye. The doctor explained that this could force the weaker eye to develop vision more properly.
How Do Doctors Diagnose Strabismus and Amblyopia?
Diagnosis:
Doctors use a variety of methods to diagnose strabismus and amblyopia. Most involve observation of how the child looks at objects, because most children are too young to recognize the letters on a standard eye chart. The doctor will cover one eye and then the other, holding and moving objects and watching to sec if the child squints or tries to cover or close one eye in favor of the other. The doctor also will check the alignment of the eyes by shining a light in both eyes to see if the reflection falls in the same place in the pupils (the black spot in the center of the cye) of both eyes.
Many children do not like to have their eyes covered during these exams. Some are frightened of the equipment that may be held close to their faces. Some techniques under development in the early 2000s used computers to track eye movements from a distance, sometimes while the child is watching a cartoon.
Treatment:
The most common treatment of strabismus involves wearing a patch like Chloe's over the stronger eye. The brain now starts to try to send and receive signals from the weaker eye, and the muscles that control it try to bring the eye back to a normal focus. The same result often is achieved with eye drops that blur the vision in the normal eye to make the other eye work harder. Doctors may also prescribe special eyeglasses for some children with strabismus. Some of these eyeglasses use prisms that change how the image is sent into the eye.
Some techniques involve disabling or weakening one or more of the muscles in the eye. This strategy is designed to force the other muscles to work harder to bring the affected eye into focus with the normal eye. Surgery can reposition the eye muscles of one or both eyes. The operation can leave the eyes straight and vision normal, although sometimes the eyes appear straight but people still need eyeglasses to achieve good vision. Sometimes, injections are used to disable one or more eye muscles for a period of time, which may achieve similar results to surgery.
Treatment is most effective when children are young, which is why vision testing and early diagnosis are important. Strabismus and amblyopia do not simply go away, as some people believe. With treatment, children like Chloe can have almost normal vision and no restrictions on activities as they grow up.
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