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Strabismus and strabotomy
Strabismus
Strabismus, commonly known as squinting, is
a defect in the eyes in which one eye is looking
in a different direction to the other. Strabismus
in children is more than just a "cosmetic
disorder" with a psychological effect on
the sufferers. Rather, it is an extremely serious
eye disorder usually accompanied by a deterioration
of the sight in one eye (amblyopy) and the loss
of spatial vision (stereo vision). Often strabismus
is trivialised as a "lazy eye" and
dismissed with the comment that the sufferer
will eventually "grow out of it".
In fact, the opposite is true. As the chances
of correcting early childhood strabismus are
reduced considerably by the time a child reaches
school-going age, babies and small children
should be examined and treated as necessary
if there is any suspicion of strabismus. The
eye doctor is supported in this by a specially
trained colleague, the orthoptist. Together
they advise the parents of the children affected
and together they monitor the success of the
treatment measures, for example, the improvement
in sight in a weak eye by the wearing of spectacles
or by covering the better eye for periods with
a bandage or foil (amblyopic therapy).
All eye movements as well as the parallel alignment
of both eyeballs in the direction of vision
are controlled by six different eye muscles.
The extent of a strabismus, the so-called squint
angle, is measured in degrees. Depending on
the deviation of the squinting eye we refer
to inwards, outwards, vertical or rotating strabismus.
Often the squint angle is very small and thus
not cosmetically significant. Here we refer
to a microstrabismus. Because in children the
squint angle is almost the same in all directions
of vision so that the squinting eye follows
the non-squinting eye with the same deviation,
this form of squinting is known as concomitant
strabismus.
In contrast to this, in the case of muscular
strabismus, the squint angle only occurs in
certain directions of vision and then usually
accompanied by a perception of double images.
There is a fault in the nerve supply to the
eye muscles whether due to an accident, nervous
or brain disorders or circulation disorders
after a stroke or in the case of diabetes. In
the case of muscular strabismus there is often
a spontaneous relapse, the important thing is
to precisely identify the causes.
Strabotomy
In a strabotomy, the flaw is eliminated by
correcting the position at the outer muscles
of one or both eyes. Depending on the squint
angle, one or more eye muscles are shortened
or moved at the point where they meet the eyeball.
In order to reach the eye muscles during surgery
only the conjunctiva – which heals very
well – has to be opened. Surgery can be
carried out on adults under local anaesthetic;
in children a general anaesthetic is preferred
so that, apart from the sedative injection,
children remain oblivious throughout the procedure.
After thorough ophthalmic examination before
the operation strabismus, surgery has a very
high success rate and there is a very low risk.
After the operation the patient will have a
mild sense of a foreign body being in the orbit
of the eye, particularly when blinking. Regular
post-op check-ups by the ophthalmologist will
ensure that the results achieved by surgery
are maintained. The treatment of strabismus
demands of all parties involved – parents,
eye doctor and orthoptist – a lot of patience,
sensitivity and psychological skill. The often
troublesome and prolonged process will be rewarded
by the success of the treatment.
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