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Strabismus limits vision development in children; affect school success and social cohesion. However, if strabismus can be treated within the first 4 months of development, visual development can continue completely normal. Acıbadem Kocaeli Hospital Ophthalmology Specialist Assoc. Dr. Feray Koç, therefore, early treatment is very important.
: What is strabismus?
Assoc. Dr. Feray Koç: Strabismus is described as slipping of the eye. Normally our eyes work like cameras. He focuses on the object we want to see and records the image and sends it to the visual center in the brain. If the brain examines the image recordings from both eyes and assembles the images with the same sharpness and quality, it makes a single image and we see this image. In strabismus, one eye focuses on the object we want to see, the other cannot focus on the same object, looks in another direction and naturally sends a different image to the brain. Since the visual center in the brain is different from the two eyes, they cannot mount them and neglect the image sent by the floating eye. Under these conditions, both the visual center of the floating eye is neglected and the image-assembly unit in the visual center does not develop.
: How long should a shift in the eye be considered normal?
Assoc. Dr. Feray Koç: Transient shifts in infants up to the first three months are normally monitored. But if the slippage continues after three months, you should see an ophthalmologist. Visual development in children continues continuously, and early treatment is important for the child to continue the normal development of visual centers in the brain after strabismus occurs. Especially in the brain image assembly unit strabismus period can not complete the task after 4 months. The longer the strabismus process, the more the visual development can be affected and even if the strabismus completely improves after treatment, the scars of this disease can be carried for life with a lower visual quality. There are various types of strabismus; some types are congenital, others can occur in older ages, especially two-three years.
: What are the most common types and treatments of strabismus?
Assoc. Dr. Feray Koç:
- Vertical strabismus: A pupil slides up or down a little more. This type of strabismus is mostly caused by the muscles that move the eye up or down cannot function normally for various reasons. If you have a child who constantly bends his head to one side or constantly raises his chin or keeps his chin down, there is a high probability of vertical strabismus. Treatment is surgical in these patients.
- Horizontal strabismus: A pupil slides inward or outward. Such strabismus may be congenital or may be accompanied by horizontal strabismus in children with various focusing problems. If there is a problem of focusing, the problem of focusing and strabismus can be solved with the appropriate glasses. If strabismus cannot be corrected completely, surgery may be necessary. Especially in children with congenital strabismus, the treatment should be performed as early as possible in order to operate the image montage units in the brain.
- In high hypermetropia: More focusing is required to see clearly, which can cause inward shifting of the eyes. The use of appropriate glasses eliminates the need for excessive focusing and improves strabismus.
- In high myopia and astigmatism: Suitable glasses make the image clearer and easier to control the shift.
- Number difference in eyes: Without proper goggles, it can cause lazy vision and sometimes slipping in one eye. Wearing the appropriate glasses without too much delay can normalize vision development and control the shift.
: What could be the consequences of late application to a doctor?
Assoc. Dr. Feray Koç: In the case of a slip type that can only be corrected with glasses, too much delay in spectacle treatment may cause the slip to settle well and develop lazy eye. In this case, the treatment process is prolonged. Only the glasses may be insufficient. Closure treatment and surgical treatment may become mandatory. ”
: When is surgery necessary?
Assoc. Dr. Feray Koç: According to the type of strabismus slipping partially corrects with glasses, the remaining amount of glasses with surgery is applied. However, after the surgery, the treatment of glasses continues. Glasses treatment and surgical treatment are not substitutes for each other. Eye glasses may be slipped when the glasses are removed in children who require eye treatment so the glasses must be worn regularly.
: Can you give us brief information about the operation?
Assoc. Dr. Feray Koç:
- Surgery is performed to ensure balance between the eyes
- A child who needs to wear glasses is scheduled to correct the slip with glasses.
- Slip amount is measured at most 2-3 times at different times and surgery is planned according to the slip amount.
- Over-function and malfunctioning muscles are intervened
- Excessive function of the muscles that reduce the power, inadequately functioning muscles that increase the strength of the process is done.
: Botox treatment is not possible?
Assoc. Dr. Feray Koc: Botox, which was very popular in the treatment of strabismus for a period, has been shown that according to scientific studies, only small-angle strabismus can provide a permanent solution. Botox may be useful in selected adult patients, but it is not a preferred method because it requires general anesthesia in children and its results cannot be predicted completely.