SQUINTING: 1 EYE LOOKS AWAY FROM THE FIXATING POINT - THAT EYE IS AUTOMATICLY TURNED OUT AND THE VISION REDUCES PROGRESSIVELY: DEVELOPMENT OF A LAZY EYE
SOMETIMES THE SQUINTING CAN ALSO EFFECT THE OTHER EYE - THAT'S A BETTER CONDITION BECAUSE THERE IS NO DEVELOPMENT OF A LAZY EYE
DURING COVERING OF THE FIXATING EYE THE BAD EYES TAKES OVER THE FIXATION. THIS CONFIRMS THE DIAGNOSIS OF SQUINTING
SQUINTING IS CAUSED BY A BAD BALANCE BETWEEN THE 6 MUSCLES OF EACH EYE
THE OPHTALMOLOGIST EXAMINS WHICH EYEMUSLE WORKS TO MUCH OR TO LESS WHILE THE PATIENT LOOKS IN ALL DIRECTIONS
MUSLES THAT WORK TO MUCH CAN BE WEAKENED - THE MUSLE MUST BE SEARCHED UNDER THE MUCOUS MEMBRANE OF THE EYE
THE MUSLE MUST BE LIBERATED COMPLETELY
THEN THE MUSLE CAN BE CUT OFF THE EYE
TO WEAKEN THE MUSCLE IT MUST BE TRANSFERRED BACKWARDS 5 MM
THE MUCOUS MEMEBRANE OF THE EYES WILL BE SUTURED ABOVE THE MUSLE
STRABISMUS = SQUINT
What is strabismus:
It's a comon disease (4%), characterized by a disorder in the cooperation of the eyemuscles: The eyemuscles are on the outside of the eye and they allow the eyemovements. When certain muscles pull to hard, the brain can't keep the eyes straight on a normal way. Strabismus is always a problem of both eyes, even if the same eye always stands in the same angle (read: the less good eye) ! Don't be surpised that almost always both eyes will be operated even if only 1 eye is crossed (mostly the worst eye).
Cause:
- Strabismus is common hereditary, when 1 of the parents has strabismus their children will (almost certain) also have strabismus. When the disorder in the musclecooperation is very bad, the strabismus is present from birth. When it is less bad the strabismus develops later (mostly between the age of 2 to 3 y), following a bad disease or when the child starts reading more.
- Childhood illnesses or accidents (like a difficult birth) can cause muscle paralysis that creates strabismus.
- With sighted eyes (spectaclesproblems, scarves in the eye after diseases, possibly during the pregnancy) the brain has no reason to keep the bad eye straight.
- Less good brain (=mental disability) struggle to maintain normal eyes straight.
Consequences:
- First and foremost aesthetic. Because children with mental disability frequently Omdat kinderen met mentale handicaps frequent look squint, the association is done: people who have strabismus aren't very smart. This is a wrong conclusion.
- Equally important is the fact that the qsuiting eye is turned off by the brain, because otherwise it gets diplopia. The lack of exercise leads to bad vision of the squinting eye ("a lazy eye"). In an accident on the only good eye, such patients can instantly get a very poor vision.
- Children with strabismus, don't see double, because the double image is turned off by the brain. Adults, that suddenly develop strabismus, will see double, because the brain lost the possibility of filtering the double image. Sometimes the strabismus isn't bad enough, so the brain can adjust. The adjustment mechanism can give headache and eye tiredness.
Treatment:
a) First we treat the lasy eye: through covering the good eye, the brain is forced to use the squint eye. The sight will get better very soon (it will not get worser !), especially when the child is very young. Once the child is 6 y we can't always expect vision training will give good results, after 8y it is impossible to try vision training. When the good eye, after training, also goes squint, we are very pleased because this is a very good sign, because this indicates that both eyes are equally strong and the brain picks one of the eyes to let it go squint. How better the eye sees, How more likely the eye will stay straight after the surgery! You still have to cover the eye till the age of 8, even after the surgery !!
b) Treatment of the strabismus: children ,who need glasses, can make big efforts to see sharp, so their eyes go squint. Glasses can be a solution for those kids. Most of the time surgery is necessary.
More information about the surgery
- When: We only operate when the strabismus is stable and when the child is ready to be examed properbly. The child has to be examed repeatedly.
Principle:
The musles, that pull too hard, should be put back +-5 mm, so they pull less hard. Regularly both abnormalities (horizontally and vertically) must be corrected, so that 1 horizontally and 1 vertically muscle must be operated and that for the two eyes (strabismus is of the two eyes together). Because of the new balans, the day after the surgery the child will possibly throw up (they feel a little bit seasick), sometimes several times. This is normal. Also the anesthesia is responsible for this. Eating after surgery can be a disappointing. The day after they can eat normal again.
Aftercare:
They have to stay a few hours after surgery. Bandage isn't necessary. Painkillers are mostly not necessary because they only feel a little bit irritation because of a light eye inflammation. Disinfecting and inflammatory drops will be prescribed during 1-4 weeks.
In the summer it is recommended to wear sunglasses, the first days after the surgery. To avoid an additional inflammation swimming and playing in the sand, during 2-4 weeks, is forbidden.
Sometimes people can see double or experience dizziness after the surgery (especially adults), because the brain are confronted with a new situation. Try to not give any attention to this. That way the diplopia will go away soon!
After the surgery they have to try to look around very soon, to train the muscles and prevent because the muscles need the training and to avoid adhesions. This can hurt the first days. When a certain muscle seems impaired, that muscle can be trained with directed exercise (such as 'look around exercises). Reading and watching tv is allowed, short after the surgery, although the patient probably won't enjoy it.
Covering (the first days) isn't necessary to let the eyes co-operate. Afterwards the covering is necessary again: the squint eye must be covered to the age of 8, to maintain good visibility. Mostly 1H to1/2 H covering per day (in the evening) is enough. .
It is usually not enough to improve the view with covering, because meanwhile musclechanges exist. In that case they have to operate again. This can be prevent by covering after the surgery!
Also glasses don't have to be worn immediately after the surgery (unless the glasses are necessary for the view). A good eye position can be obtained without glasses. In this case the doctor can decide to illuminate the glasses or even not wearing the glasses again.
Regular eye examination are necessary. Mostly: the day after surgery, after 1-3 dayes + after 1 week and after 1 month. The later controls depent on the age of the patient and the results of the operation.
Successrate: after 1 operation 9/10 of the patients have normal eyes again. The most important obstacle isn't the surgery. The surgery only brings the eyes straight. The brain has to keep the eyes straight. There it can go wrong: the worser the eyes and/or the brain function, the less chance there is that the eyes will be normal again after 1 operation. When the eye is straight immediately after surgery, it is a good sign! BUT only after 6 weeks you can see the endresult.
When the eyes don't stand straight after the first surgery, you need to know that a strabismusoperation can be done several times. Sometimes a converging strabismus can, after surgery, capsize to a divergent strabismus. This isn't bad, we can operate this easily.