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Esotropia is when one or both eyes turn inward toward the nose. This can occur at any age, but usually seen in children between the ages of 6 months and 6 years. When the eyes are not aligned together, the brain will choose to use one eye over the other and this can lead to permanent vision loss, commonly known as lazy eye.
Not all Estropia is the same. Some can be treated with eye glasses, some require surgery, and some types require both. If lazy eye has begun to develop, patching the “good” eye is necessary to restore vision in addition to the glasses and surgery. In select cases, dilating eye drops (Atropine) can be used with or instead of patching.
Exotropia is when one or both eyes drift outward toward the ear. Again, surgery or glasses may be necessary to correct the problem and restore eye muscle alignment.
Anisometropia is a functional defect of the eyes, where unequal refractive errors in the two eyes result in unequal vision. A brighter right reflex indicates the need for glasses.
One or both eyes drift up or down. This can occur at any age, and in adults can be found after head trauma or stroke. Often times a compensatory head tilt occurs to help the brain see a single image. Again, surgery or glasses can help correct the problem.
Nystagmus is a dancing of the eyes, usually horizontal, moving back and forth at various speeds. Usually, this is congenital, but it can be acquired. In congenital cases, the cause may be anatomic, such as a cataract or small optic nerves, or idiopathic. Anatomic patients usually do not benefit from muscle surgery unless vision is quite good. Idiopathic patients do especially well if vision is 20/100 or better. The surgery consists of cutting the inserting tendon and leaving the muscle in place. If there is an attendant deviation, that can be incorporated into the surgery. The surgery slows the nystagmus allowing an increase in foveation time and therefore improved acuity.
Post Strabismus Surgery
Blood vessels under the conjunctiva may leak during surgery which may cause blood vessels to leak on the white of the eye or drop of blood in the tears.
AVVDA Cibis Test- Red reflex photos, examples of which are above, are used by Dr. Cibis as part of his examination. Called Automated Video Vision Development Assessment, the Cibis Test for short, these video clips can be used to screen children for amblyogenic factors. A computer program analyzes the video frames for alignment, refraction, and need for glasses.
Implants: This is a clouding of the eye’s natural lens (behind the pupil) which may make the inside of the eye appear “white”. Pediatric cataracts may need to be removed by surgery on an urgent basis to allow visual development. Once the lens has been removed, glasses, contacts or implants may be necessary to help focus the image in the eye.
Adults: Adult cataract surgery routinely uses an artificial lens implant to restore vision, but not until recently has the technology become available to do this procedure in children. Implants have been done on children as young as 12 months with great success.
Adult: There may be a gradual discoloration of the natural lens leading to gradual vision loss in older adults. Surgery is an option when the cataract interferes with the lifestyle of the patient and limits their activities.
Nasolacrimal Duct Obstruction
This is usually seen in infants between birth and 6 months of age. Chronic obstruction can lead to infections of the tear sac at any age. The eyes will appear watery and often mattered with discharge. Early treatment includes antibiotic drops and massaging of the tear duct. If resolution does not occur by 6-8 months of age, a probing surgery is indicated.Probing is done under anesthesia, and is successful 90% of the time. This is done using a thin, blunt metal wire where it is gently passed through the tear drainage. In instances where it is not successful, tubes (called stents) are used and left in place for up to 6 months.
A droopy eyelid that can occur at birth or after trauma. Usually not progressive in children, but can appear worse as the child’s face grows. Severe drooping can interfere with visual development and lead to “lazy eye”. Surgical repair can be helpful to lift the eyelid, but may not restore eyelid muscle function.