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Strabismus, the condition that makes adults go cross-eyed

Strabismus, the condition that makes adults go cross-eyed

Eye health. Look out for eyes becoming misaligned when older as this can be a sign of some serious medical issues

Carmen Barreiro

Friday, 4 August 2023


Gonzalo has suffered with strabismus from a very young age. His parents noticed "something strange" with his eyes and consulted the paediatrician, who referred them to a children's ophthalmologist.

"I'd been wearing a patch for a long time, but the deviation in my right eye wasn't completely corrected," he explained.

He never gave it too much thought "because it didn't affect my daily life at all... Until I entered secondary school and I started thinking 'What if they call me cross-eyed or El Dioni' [an infamous thief known for being cross-eyed]... For years I was very self-conscious so, as soon as I could, I had surgery to correct it. I had a bit of a hard time post-op because at first it made me dizzy, but now I'm delighted," said this 40-year-old nurse who jokingly calls himself "big blue eyes".

"It can be said that strabismus is a lack of ocular alignment. That is, the eyes do not focus in the same direction, they are misaligned. And this vision disorder can point horizontally, vertically or off at an angle. For example, the right eye can look to the right, and the left can look upwards. Or one down and the other to the left," explained Dr Nagore Urrestarazu, a specialist in paediatric ophthalmology and strabismus at the Clinical Surgical Institute of Ophthalmology (ICQO).

Lazy Eye and other causes

This distortion in how the eyes line up straight affects approximately 3% of the population and can occur at any age, although it happens more frequently in childhood, especially after 2 years of age.

"Congenital strabismus, for example, starts at birth and is usually hereditary, but there are other factors that can contribute to the development of this ocular disorder: premature birth, the famous lazy eye in children, but also neurological problems, diabetes, hyperthyroidism. .. And at other times it crops up in isolation. That is, it is not associated with any specific medical condition.

Now, when strabismus appears suddenly in adulthood, a specialist should be seen because it can hide a serious disease such as a tumour, brain damage, other head injuries..," warned the ophthalmologist.

Although most adults with strabismus have had it since childhood, sometimes this vision disorder occurs at a later age. In these cases, one of the most common symptoms – in addition to the characteristic crossed eyes – is that the person tends to see double.

"This is because the brains of these people have already learned to receive images from both eyes and are now unable to ignore what is seen through the misaligned eye, so they perceive two images," said a spokesperson for the American Society of Ophthalmology.


When should we consult a specialist?

"For a baby under six months the goal is to ensure the misaligned eye is manageable and within the normal range, as long as it is not a significant misalignment. But, if after that age we notice that the child still has a vision disorder or there is a family history of strabismus, it is important that we consult an ophthalmologist to see what is really going on. It is not an emergency, but we should treat the consultation preferably as a priority," advised Dr Urrestarazu.

Strabismus generally requires treatment, although there are some types, such as divergent squint (the affected eye or eyes point outwards), "in which the only 'problem' is cosmetic. Cross-eyed people are still the butt of ridicule and many are very self-conscious.

In fact, an important number of patients who decide to undergo surgery once an adult do so purely for aesthetics," said the ophthalmologist.

When misaligned eyes occur in children, it is usually associated with a lazy eye and is almost always corrected with an eye-patch and glasses. In certain types of strabismus, botulinum toxin (botox) can also be used to re-align the eyes, while in others, the most effective solution is surgery.

"It is surgery in which the patient goes home the same day and the post-operative period is quite bearable, although a few days off are recommended because the eye muscles are slightly bruised by the procedure. The results are visible after about three weeks. In the case of adults, it is common for them to feel dizzy for the first few days because they have to get used to the new position of their eyes," said Dr Urrestarazu.

Diplopia or double vision

Diplopia is the vision disorder whereby the person sees two images of the exact, same object. In other words, the person who suffers from diplopia sees double.

"And this double vision can be horizontal, vertical or contorted, depending on whether the images are superimposed one on top of the other, to the side or diagonally," explained ophthalmologist Pilar Gómez de Liaño, president of the Spanish Society for Strabismus and Paediatric Ophthalmology

This visual impairment can also affect both eyes (binocular) or only one (monocular).

Furthermore, double vision, which can occur at any age, is not always constant. That is, the patient does not see double all the time. In fact, most often diplopia will onset intermittently or at specific times. However, experts agree on the importance of seeking medical attention urgently for any episode of double vision, since the causes can be very serious.


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