^{By Rhcastilhos and Jmarchn - CC BY-SA 3.0, Link}

We all have that one friend with half past four eyes. Some individuals tend to like it, while to others, its a serious pain in the ass. Let me stroll you down a memory lane of mine.

Sotonye happens to be my roommate back then in college, he had some sort of what most ladies around call a sexy half past four eye. He is a very intelligent and talented fellow and everything went smoothly, until one day he came back from lectures and broke the news to me "Akiri I have been scheduled for an eye surgery".

This got me thinking and asking lots of questions like, "are your eyeballs going to be pulled out? I thought people see your half past four eyes as the sexy type". Well, fast forward to two months down the line, he went in for the surgery and it was totally successful. I continued my funny questions after Sotonye's surgery, "did they pull out your eyes? will it take years for you to completely recover?" He is living perfectly fine today. This was really an eye opener for me, getting to understand the eyes musn't be pulled out in order to perform an eye surgery for strabismus.

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Introduction

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Strabismus is a vision defect that occurs when an individual cannot align his two eyes at the same time. Strabismus can stop or start at irregular intervals. Each of the eyes look at different directions while trying to look at a particular object. So the next time you see a child with this eye defect, have it at the back of your heart that this defect can be treated. This is one of the most popular eye defect in children. Strabismus is otherwise known as crossed eyes.

When strabismus is a case of inward misalignment, it is called esotropia or crossed eyes. When its a case of outward misalignment, the case is called exotropia or wall-eyed. Upward misalignment is another case, called hypertropia. Downward misalignment is known as hypotropia.

There are six distinct muscles that surrounds each of the human eye. they are distinct but work together. This is what allows us focus on a particular image. Strabismus is an eye defect which happens when these six muscles fail to work together, resulting in the two eyes focusing on different objects at the same time.

Especially during childhood, this creates a confusion in the brain of the individual and adapts the individual to suppressing whatever image coming to the weaker eye.

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Where does Strabismus come from and why should we care?

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Strabismus is one of those complicated diseases whose root cause isn't certain. However, there are certain risk factors that could possibly lead to this eye defect, which includes certain abnormalities in the nerves and muscles around an individuals eyes.

It is often advised to tackle strabismus at an infant state because it could be an indication of an even more severe eye defect or other diseases. Most children with this defect are born with it, while for others, it comes up during their childhood period.

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Amblyopia (Lazy eye)

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Like I said earlier, if strabismus is unattended to, it could lead to even more severe complications. One of such complications that leads to loss of vision is known as amblyopia

Amblyopia eye defect is hugely connected to the brain. If an individual with Strabismus focuses on an object, there is a serious confusion that takes place in the person's brain. The brain tends to receive double visualization instead of one.

In most cases, the brain tends to disregard this double visualization from the defected eye especially in childhood. Persistence of this disregard, eventuality leads to poor vision. Good news is, this eye defect can be treated in childhood. Early detection and treatment of strabismus and amblyopia gives the child a higher chance of developing a 3D vision (depth perception).

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If you experience any of these, you might want to see your doctor

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Often times, strabismus is quite difficult to notice in children, especially if the case is a minor one and cannot be recognized cosmetically. This is why it is best an individual gets examined by an ophthalmologist once any of these symptoms are noticed, including: low depth perception, double vision, crossed eyes, loss of vision. For individuals that develop a misalignment of the eyes in adulthood, it is advised you see an ophthalmologist because it could be a sign of other health conditions like stroke

Just like many other disease type, strabismus is best corrected with early detection and treatment. it is also important to understand that the case of strabismus is different in each child, hence the need for tailored treatment pattern in most cases. There are different treatment options available for treatment of strabismus. Some of them include:

1. Use of eyeglasses

eyeglasses are usually suggested in order to straighten a childs eyes. in certain cases like that of accommodative esotropia, glasses are often prescribed, basically to help trim down the effort in trying to focus the eyes on objects.

2. Eyepatch

In most moderate strabismus cases, eyepatch is often recommended. This involves blurring a part of the eye (the stronger eye), in order to increase the work of the weaker eye, so as to improve amblyopia

3. Surgery

Surgery is often required for children with esoptropia. This is for realignment of the eyes. Surgery is also needed when there is persistence in crossing of an individuals eyes, even after the use of prescribed glasses.

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Does the eyeball get removed during surgery?

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I know there are other individuals like me, who often wonder, especially at a tender age, if an eye surgery requires pulling out the eyeball entirely and having it worked on. Well, it is best we understand the fact that ** removal** of the eyeball is never a requirement during the treatment of any kind of eye issue with surgery.

Basically, what the ophthalmologist does is to make a little incision in the tissues surrounding the eye, This is done, in order to separate the muscles of the individual from the wall of the eye, for proper access during surgery. Glasses are mostly prescribed after eye surgery

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What are the available therapies for Strabismus

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Physical therapy - This is a surgical therapy, that helps strengthen the eye muscles. No need to be very scared, your eyes do not have to be pulled out before an surgery can be carried out. This therapeutic approach is observed mostly in the early stage of strabismus, so the brain does not adapt to the patients flawed visualization pattern.

Vision therapy - This is a nonsurgical therapeutic approach. This therapy works hand in hand with the patients brain. In this therapeutic approach, the brain is trained for proper alignment and focus of the patients eyes for proper visualization of images. The optometrist often arranges certain activities/exercises to strengthen the patients eye focusing strength, so as to make the eyes and brain work in sync.

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Surgical procedure for treatment of Strabismus

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The first step involves weakening or strengthening the muscle of the eyeball. To do this, the surgeon first creates a shallow opening directly into the eyeball's outer layer.

To strengthen the patients eyeball muscles, the surgeon removes a little section from one end of the eye's muscle, so as to shorten the eye muscle and realign the stitched eyes to the direction of that muscles. He then stitches it back together after the surgery.

Weakening a patients muscle, is quite different from strengthening them. This case also involves making a slit across a particular end of the eyes muscle, but this time, no section of the eye muscle is removed. Instead, a space is left at the part where the muscle was slit. After that, the muscle ends are stitched together, using a thread. The patients in most cases, experiences double vision for quite a few weeks after this surgery. Within this period of time, the brain has no choice but to adjust to the new pattern of visualization.

Conclusion

Strabismus is a very popular eye defect which is detected mostly at a tender age, and could get very complicated if not properly attended to. Abnormalities in the nerves an muscle surrounding the eyes are the major risk factors of Strabismus. If detected early enough, an ophthalmologist could suggest different treatment types, including eyepatch, eyeglasses, or surgery.

Thank you,
written by: @akiripromise

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[1] Strabismus treatment

[2] About strabismus, medicinenet.com

[3] Strabismus disease

[4] Your eye concerns

[5] Strabismus in children

[6] A complete guide to strabismus

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