Strabismus

Squint or Crossed Eyes

Strabismus has been one of the least clearly understood phenomena in ophthalmology.

In fact, the eyes must turn in, in order to look at anything at a distance less than infinity.

That means the whole process of looking at a distance less than infinity is a process of squinting only, in the strict sense of the term!

Now the two eyes must turn in correctly as well as equally when looking at an object at a distance less than infinity.

If the two eyes don't turn in in harmony with each other, or if they turn out, or if one eye turns in and the other turns out, or even if they both equally turn in more than mathematically justified or don't at all turn in when looking at an object at a distance less than infinity; strabismus ensues.

Causes of Strabismus:

• Muscle Habits: The brain develops a compromise with the muscle habits so that fusion does occur even when the two eyes are not equally converging at the same object. Such a condition is known as anomalous retinal correspondence.

• Muscle Injury: A muscle injury to one side of the converging system may develop a psychological paralysis to that side of the muscle system that obstructs with the proper converging over there.

• Muscle Trauma: A myositis syndrome to one side of the converging system may develop a psychological paralysis to that side of the muscle system that obstructs with the proper converging over there.

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  Brown's Syndrome
  

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  Brown's Syndrome: After Treatment
  

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• Inappropriate Development of the "Fusion Center" in Brain: It's again a habit, and all habits stop muscles as well as brain from working in a naturally correct way; hence their psychological paralysis! All habit stays there in the mind and from there only it affects the improper working of the muscles, nerves or/and brain.

• Suppression: One of the eyes can suppress or turn off one of the images in the brain to avoid double vision (diplopia) and end up in amblyopia.

• Diplopia: Because the two eyes are not equally converging, it will naturally end up in seeing two different images resulting in diplopia.

Types of Strabismus:

• Constant or Intermittent Strabismus: When the unequal/unjustified eye turn occurs all of the time, it is called constant strabismus. When the unequal/unjustified eye turn occurs only some of the time, it is called intermittent strabismus.

• Esotropia: Inward turning of the eyes

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  Credit: National Library of Medicine, National Institutes of Health

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• Exotropia : Outward turning of the eyes

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  Credit: National Library of Medicine, National Institutes of Health

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• Hypertropia : Upward turning of the eyes

• Duane's Syndrome 1: Inability to move an eye laterally away from the nose with widening of the eyes

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  Duane's Syndrome
  

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• Duane's Syndrome 2: Inability to move an eye laterally toward the nose with narrowing of the eyes

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  Duane's Syndrome: After Treatment
  

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• Duane's Syndrome 3: A combination of Duane's Syndrome 1 and Duane's Syndrome 2

Treatment of Strabismus:

• Orthoptics: Orthoptics looks at muscle problems only in regard with their strength and not in regard with their agility that comes from an agile brain that is free from all kinds of static habit patterns.

• Strabismus Surgery: A very controversial treatment method as far as strabismus is concerned! It concentrates on cosmetic improvement more than the real functional one. Surgery is not able to make the eyes work better as a binocular (two-eyed) team.

• Vision Therapy: Vision therapy is the only properly comprehensive treatment of any kind of strabismus. All strabismus has one thing in common, and that is that it affects the central fixation of the eye in a negative way. Or it can be taken the other way round - when the central fixation is lost; strabismus ensues, whether overt (obvious) or covert (in-obvious). In fact, almost every single person on earth is strabismic whether to this or to that extent. With declared strabismics, this condition is only obviously more so. As soon as the eyes achieve their central fixation through vision therapy, strabismus goes away both cosmetically as well as functionally.

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