Strabismus - Pediatric Ophthalmology

Strabismus - Pediatric Ophthalmology

How often should children be examined?

Even if there are no complaints regarding the eye of the child, it is of great benefit to perform an eye examination within the first year after birth in order to detect congenital anomalies. If no problem is detected, the eye examination is repeated at the age of 3-4 years and before starting school.

Due to the excess of visual stimuli such as intensive computer use, television, and studying from screens, refractive errors have been detected in the large portion of children in recent years, therefore it is beneficial to have an eye examination at least every 2 years, even in children who do not have symptoms. If the need for glasses is detected during the examination, the examination is repeated every year or every 6 months.

With the pediatric autorefractometer used in our clinic, eye defects can be easily detected even in young children.

What is strabismus?

When the eyes are not aligned parallelly when looking straight ahead, it is called strabismus. This is due to the dysfunction of one or more of the 6 muscles of the eye.

What is false strabismus (Pseudostrabismus)?

Strabismus is a condition commonly seen in babies where the flattening of nasal root reveals the impression of inward shifting of the eye, especially during side gaze. This condition, which can also be seen in facial asymmetry and eyelid anomalies, is called pseudo-strabismus or slippage. No treatment is required for false strabismus.

What are the causes of strabismus?

Strabismus may be congenital or it may occur due to refractive errors that are not corrected (myopia, hyperopia, astigmatism), eye muscle anomalies, neurological diseases and trauma.

What are the symptoms of strabismus?

  • Eyes looking in different directions
  • Headache
  • Double vision
  • Closing one eye in bright light
  • Gaze with the head tilted to one side
  • Blurred vision

When should babies with a suspected strabismus be taken to the doctor?

A misunderstood belief about strabismus is that strabismus may be normal until the child reaches a certain age. Unfortunately, some pediatricians can guide patients in this way. The truth is that all kinds of shifts are pathological. Since conditions such as congenital cataracts and intraocular tumors can cause strabismus, it is necessary to see an ophthalmologist immediately in suspected cases.

What methods are used in the treatment of strabismus?

1) Wearing glasses: The most common cause of strabismus is uncorrected refractive errors. In the treatment of such conditions, which occur especially around the age of 2-3, it is absolutely necessary to use glasses. With glasses, both the quality of vision increases and the strabismus mostly disappears. It should not be forgotten that the treatment of strabismus is a long and troublesome process.

2) Eye patches : It is a treatment that must be applied in cases where amblyopia develops due to strabismus or the difference in eyesight number of the two eyes.

3) Orthoptic treatment: It is the treatment applied to increase the visual ability and three-dimensional vision.

4)Surgery: It is a method used in cases that do not develop due to a refractive error or cannot be corrected at the desired success rate with glasses. Surgical treatment is not a treatment to get rid of glasses. If necessary, glasses continue to be used after surgery.

What is lazy eye and how is it treated?

Lazy eye is when the corrected visual acuity of one eye is lower than the other eye. Sight is a skill that the brain learns from infancy. If there is not enough stimulation from one eye to the visual center in the brain due to reasons such as strabismus, high eyesight number, and congenital cataract, the visual acuity of that eye will be lower than the other.

In the treatment of lazy eye, it is essential to eliminate the underlying problem and to operate the lazy eye by closing the healthy eye.

When should an eye examination be done in children?

Eye examination in children should be done starting from the newborn period. The first examination is done by an experienced nurse or pediatrician in the newborn department. Then, a general eye health examination should be performed by an ophthalmologist at 6 and 18 months. Even if the eyes look completely normal, the first visual examination should be performed at the age of 3 years in order to detect lazy eye.

Amblyopia - What is lazy eye?

Sight is a skill that the brain learns from infancy. While the baby distinguishes silhouettes when he is just born, he learns to see colors and three-dimensional vision in the usual sense when he is about 6 months old. Visual development continues until the age of 8 in children. If there is a higher refractive error in one eye than the other, a misalignment, cataract, or one-sided drooping of the eyelids, then the affected eye learns to see blurry. If it is not treated in infancy and early childhood, this condition becomes permanent. When diagnosed early, in the first 8 years of life, treatment is possible.

Lazy Eye Treatment:

For the treatment of amblyopia, the well-sighted eye is closed to force the use of the under-developed eye. The simplest and most easily applicable treatment is the eye patch treatment. In addition to or as an alternative to eye patch therapy, pleoptic therapy and penelization treatments can be performed.

Cambridge Eye Stimulator (CAM therapy) is a treatment method used to increase visual acuity, 3D vision, the sense of depth and the contrast sensitivity. With this treatment, it is aimed to improve vision in 10-20 sessions by having children aged 5-15 paint on contrast discs.

By using NeuroVision computer and a personalized program, with studies done at home in sessions; this treatment program enables the perception of images in the brain. It is aimed to increase visual acuity and quality by increasing contrast sensitivity with visual stimuli for children aged 10 years and older.


The first thing to look at is the presence of adnexa, integrity, dimensions of the eye and it’s compatability with the orbita-face. If an infected red eye is detected, systemic antibiotic therapy is applied. Corneal transparency, size, pupillary asymmetry are evaluated with a direct light examination. With the examinations performed congenital glaucoma, congenital corneal trauma, corneal endothelial dystrophies, anisocoria, iris and angle anomalies can also be detected. Temporary medical and surgical treatment is applied for buphthalmos. A unilateral congenital cataract should be operated within six weeks. If there is no retinal reflex in bilateral cataracts, intervention should be done as soon as possible.


Physiological development periods should be known. Central foveal fixation and slow tracking eye movements begin in 1-1.5 months. Accommodation, contrast sensitivity, and foveal maturation develop up to 4-6 months. Most babies born with hyperopia complete their anterior segment development at the age of three and enter the emmetropization process. For visual acuity measurement, the only observation of fixation is whether it is in both eyes. In monocular fixation, central nervous system pathologies, asymmetry and saccadic movements are examined. In binocular fixation, anisometropia and Infantile strabismus is evaluated with the vertical prism test.

Congenital ptosis is followed closely. The refractive state is determined by retinoscopy with cycloplegia and autorefractometry. If there is no suspicion of strabismus, nystagmus or low vision in the eyes, 3D and low hyperopia are not treated until 3-4 years of age, since they do not cause lazy eye. Increasing hyperopia between 1 and 4 years of age causes strabismus and more amblyopia. 6D and above myopia is corrected under one year of age, and 3D and above myopia is corrected between 1-5 years of age. Congenital esotropia and exotropia should be operated within one year. Lacrimal duct obstructions should be treated. All conditions causing leukocoria such as retinoblastoma and vitreous detachment should be treated surgically.


Preschool children are very active. They know their doctor. They contact us. We can determine their visual acuity. They see as much as adults.

-Astigmatism >1.5D

-Hypermetropia >+2D

-Myopia >-4D and above should be corrected with glasses.

Detection and treatment of accommodative disorder, anisometropia and amblyopia are important.

6-12 AGES

This age group gets acquainted with school and education, tells their complaints. They can describe the classical picture of optic neuropathy. In the detection of ever-increasing myopia, the presence of keratoconus is definitely detected by corneal topography.

12-16 AGES

It is the period of adolescence. He is an individual who understands everything we talk about in reverse. The posterior segment completes its development. All kinds of eye diseases occurring are called juvenile. Hyperopia is not corrected until 1D. Myopia and astigmatism should be corrected with glasses as successfully as possible.

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