so are you a friend or a family member cross-eyed? in eye care we call that having strabismus and it
can cause a lot of problems with our eyesight and vision so in this video we're gonna break
down what is strabismus so that you know what's going on and what you can do about it plus stay
tuned toward the end because i'll explain to you how i'm able to make my eyes look
like they're cross-eyed even though they're not that's today's video let's take a look
hey welcome back this is Dr. Allen here from the Doctor Eye Health show helping you learn all about
the eyes vision finding the best vision products if you like learning about the eyes vision taking
care of your eyes seeing your best consider hitting the subscribe button down below and ring
the bell so that you don't miss any of our future videos now let's just imagine that you're a parent
and you took your child into an eye exam and the doctor said something about your kid having
an eye that's turning inward some of the time and that they may have strabismus or that they're
developing lazy eye or maybe you read through the chart notes and you saw something like Esotropia
and you're like i don't know what that means and in the eye care world when somebody has an eye
turn meaning both eyes are not looking straight ahead instead one eye's either turning off to
the side or turning inward or up or down we call that having strabismus and this happens to be one
of the most frequently requested topics on this channel so thank you to all of you guys who are
subscribed and are active in the comments section i really appreciate that and having strabismus can
lead to a lot of vision problems especially later in life and the sooner we catch it the better
that's why i am such a huge advocate for pediatric eye exams and people having their children
examined by an eye care professional early on in life because a lot of just the vision screenings
done at schools or like the vision check in the hallway at the pediatrician's office often misses
strabismus and these different types of eye turns especially if they're really small so for all of
you parents out there i strongly encourage you if you haven't had your kids eyes checked and
they do have maybe a subtle turn in their eyes or anything like that definitely go get them checked
out with an eye care professional and that's even if your child doesn't complain that they
have a vision issue because they often don't even know it they just have learned what their vision
looks like and they don't know that they're not seeing well now there are many different types
of strabismus and the nomenclature that we use in the eye clinic can be a little confusing if
it's new to you so let's just briefly go over the different types so that you can easily understand
kind of what we're dealing with first of all our two eyes are meant to be looking straight ahead
and they're supposed to kind of turn in unison kind of like the wheels of a car they're supposed
to turn left when you're looking left they're supposed to turn right when you're looking right
but if somebody has an eye that just turns inward while the other is looking straight
we call that having an esotropia anything that's turning inward we denote as eso and if somebody is
looking with one eye straight ahead and the other eye is kicking outward we call that having an
exotropia and then it's also possible for an eye to be tilted upward which we call
hypertropia and then we have somebody who has an eye that's going downward and we call it
having a hypotropia it's also possible to have a mix of both an esotropia and a hypertropia
different angles like that with these different deviations from straight ahead in the clinic we
like to measure and actually quantify how much of a deviation it is so we'll measure that using
prisms and we'll denote it as something like 20 prism diopters of Esotropia then of course we have
to label it is it the right eye is it the left eye or perhaps it's alternating it's going from one
side to the other and that is possible one eye may look turned in at one point and then at another
time the right eye may be turned in while the left eye is looking straight ahead it is also possible
for this eye turn or the strabismus to be constant meaning it is all the time or it is intermittent
meaning it's only some of the time then your doctor can also measure this deviation and how
severe it is in different directions of gaze and if it's the same amount in every direction
we call that having a comitant deviation and if it's not the same in every direction then
we call it being incomitant or non-comitant now these are just the basics of these different eye
turns that we can have there are also many other types of syndromes where the eye muscles don't
quite work the way they're supposed to things like duane's syndrome or brown syndrome those
are those are special cases and that maybe won't be able to have videos about those in the future
but for most of these basic cases if somebody has like an esotropia where an eye is turned inward or
an exotropia where the eye is turned outward most of these cases are labeled as being congenital or
infantile strabismus something that occurs early on in life for example a child may be
born or in early development has an eye that is stuck or is turning inward all the time
usually within the first six months of life a baby will have some minor deviations in their
eye muscle movements but by about that six month mark they should be pretty well straight ahead
so if you know somebody who has a child over the age of six months and they do have a suspected eye
turn definitely get them checked out as soon as possible however at that young of age it is also
possible to have something like a pseudo esotropia where it looks like the eyes are not looking
straight ahead they look like they're crossed but in fact the eyes are looking straight ahead and
the child just has really large epicanthal folds meaning they have a lot of excess skin nasally
kind of a flat nose bridge appearance and it just kind of looks like their eyes are going crossed
that's again why it's so important to bring your child in so that your doctor can really examine
and determine if that is the case now outside of being born with a strabismus it's possible
for somebody to acquire strabismus especially for young kids again around the age of two to three
a child starts to develop their ability to really accommodate or focus on a near object think of it
like two three years old everything in your world is right in front of you things that you can grab
toys all those different things and this is where stir business can start to get really complex and
the whole idea of what's called accommodative esotropia is probably something that deserves
a video all on its own because it does get rather complex but i do think it's important to briefly
mention because it does illustrate how important both our prescription or our refractive properties
of our eyes influence the posture of our eyes and where our eyes sit and look in the different
directions of the world and how they can even influence the development of something like an eye
turn or strabismus again at a younger age children are focusing a lot on their near surroundings
and if your child has a hyperopic or far sided prescription they already need to use their
eye muscle inside their eye that muscle is called the ciliary body and they have to use that muscle
to focus to even see things in the distance clearly so when they are focusing on a near
object they have to use their muscles even more and the interesting part about eye care and just
the eyes in general is that that muscle this focusing muscle to keep an image clear up close
is neurologically tethered to the same muscles that turn your eyes in and outward and we call
that convergence and divergence so when your eyes are converging and they're focusing it basically
is pulling it all together and so for one of those children for example when they're looking at
a near object their eyes are going to compensate for this high amount of near focus by also pulling
the eyes in together forcing them to basically go cross-eyed and this becomes a major problem
as with a lot of people who do have a strabismus or one of these eye turns is that eventually the
brain starts to have trouble holding that position and one eye tends to want to give up and just kind
of kick out or not be in alignment and as you could imagine that often results in something
like double vision or diplopia as we call it in the eye clinic and our brains do not like
double vision it's very difficult to see you can't really function and understand what's going
on so our brains as magical as they are have learned to adapt to this subtle double vision
by doing something called suppression and that's where our brain just even though it's able to
see these two images just decides hey that's confusing i'm just gonna mute off that eye that's
not working right it usually ends up being the eye that's working too hard and doesn't have as
clear of an image and hence it usually ends up giving good eyesight out of one eye and not the
other and although how the brain suppresses this other eye is advantageous in that we're not seeing
double it does cause some other neurological consequences with visual development namely a
condition called amblyopia or having a true lazy eye and we did a video on amblyopia and lazy eye
last year and if you want to know more about that again that's another really
in-depth topic of discussion in fact i had to take full dedicated courses on things like strabismus
and amblyopia and the treatment the management of it when i went to school for eye care so i do have
a dedicated video on that and i do encourage you to check that video out i'll put that up in the
youtube card above here as well as in the youtube description below so you can open it up and watch
it at your leisure just to learn a little bit more now outside of having strabismus as an infantile
reason at a young age or accommodative reason you can also have them for acquired reasons later
on in life and this could be due to head trauma being struck in the head really hard it could be
from other medical causes such as severe diabetes or something tragic like having a brain
tumor or an aneurysm anything that affects your neurological connection to your eye muscles these
different forms of acquired strabismus are often called paralytic strabismus as the muscles are
paralyzed for some reason for example if you have head trauma it usually ends up damaging the fourth
cranial nerve which controls one of the superior oblique muscles to the eye it's usually the most
commonly damaged in trauma leading to problems with vertical diplopia or if you have increased
intracranial pressure this can push on the sixth cranial nerve which controls the outward movement
of the eye and if you can't do that then your eyes are naturally gonna kick inward or again if you're
somebody who has a long history of uncontrolled diabetes or high blood pressure this can also
cause problems with the eye muscles thankfully in those cases it's usually transient and does
get better on its own within several months a big differentiating factor between young kids with
strabismus and adults with acquired strabismus has to do with the symptoms and that's mainly
because adults being that they've already learned to see the world with both eyes working together
when you suddenly have this deviation in one eye compared to the other then you typically will have
double vision or diplopia where young kids who've developed strabismus at a young age have again
learned to suppress an eye and often end up with something like a lazy eye and so they don't end
up seeing double vision and all of this does play a role in how we treat and manage these different
conditions so when it comes to the different types of strabismus treatment and things that you can do
first of all young kids need to get strabismus diagnosed and with an eye care professional so
they can start managing what's going on and really how we can start treating it the first and easiest
treatment for most people especially for infantile causes of strabismus is first glasses again the
power or prescription of glasses the refractive air usually a lot of these kids are farsighted
and in that case wearing glasses may correct the problem at large but again usually it's better
if caught earlier because our main goal with strabismus at a young age is not just to correct
the eye and get it looking straight ahead but to prevent neurological male development of the
visual processing centers and that has to do with again that term amblyopia or lazy eye preventing
lazy eye from settling in and outside of just glasses especially for young kids who are at risk
of amblyopia or lazy eye your doctor will also usually prescribe some type of occlusive therapy
this involves using an eye patch or some type of atropine eye drop to the better seeing eye
to try to penalize the better seeing eye and force a young child to start utilizing the
eye that's not coordinated not looking straight ahead isn't developing as well sometimes glasses
can be outfitted with prisms built into the glasses to help shift the retinal image into
alignment with both eyes that is a possible way to help people especially adults who have
permanent strabismus where they're just constantly seeing double that way you get rid of the double
vision usually prisms are ground into the glasses permanently but there are also temporary prisms
called fresnel prisms which are kind of a press-on to the glasses sort of thing there are some other
eye muscle movements such as vision therapy or also known as orthoptics which may have a
small role in strabismus usually in my experience it's more for acquires to business after something
like a traumatic brain injury may have a little bit better effect but it is something that
may be included in recommendations but for many people both infantile as well as adult strabismus
especially if it is a large deviated angle whether it be eso, exo or anything often times
surgery is needed for strabismus for bismuth surgery can be really important especially
again in the younger ages because it can get both eyes to be relatively in alignment then we can
again get the brain to develop good vision even in the first place because the brain can learn
really well we call that having neural plasticity and it's usually much better
in younger ages around the age of 8 9 all the way up to maybe 12 then it starts to continually
kind of go downhill and we have a harder time with that neuroplasticity but for people who are older
in cases of let's say adults to business it is also possible to have these eye muscle surgeries
too oftentimes people will do this for cosmetic reasons because it can be pretty devastating
i've had people comment down below about their experience growing up and being teased or bullied
as a kid or as an adult because their eyes are going in different directions and it looks
unsightly and people just don't know how to react to it when one eye is off looking a different
direction which is really tragic and you can see why somebody wanted to get strabismus surgery can
can be a big thing for them but unfortunately as an adult if somebody already has amblyopia rooted
in and they decide to get strabismus surgery later in life to have both eyes looking straight
it may make the eyes cosmetically look orthoptic or looking straight ahead but it doesn't
necessarily waken up that eye and make it seem better because it's not necessarily the eye or
the receptor that has the functioning problem it's really the processing centers for that eye within
the brain now i know again that strabismus and amblyopia all of this can be a really complicated
topic but i encourage you to drop your comments in the comment section below any questions you have
let us know your story have you had strabismus or a amblyopia since you were young do you have
a family member who is going through this and you want to connect with other people who have maybe
gone through it too definitely connect with other people in the comment section i want this channel
and these comments to really connect people to encourage other people and just kind of learn from
everyone's experiences for a little change of topic i've had people ask how i'm able to make it
look like i have an eye turn or that i have some sort of an esotropia even though i really don't
and i just want to kind of share this as kind of a fun thing i don't encourage people to try
this on their own and try to hold it for long periods of time but it's just a matter of again
trying to look at the tip of your nose trying to go cross-eyed and in the distance if you hold that
everything should go double like right now i'm seeing two of everything i'm seeing two
different cameras and that is normal that's called physiological diplopia such if you look at one
single object like keeping your finger single here in the back distance i see double of everything
but if you're able to go cross-eyed see double of everything focus on one image again there's two
cameras if i focus on the camera over on this side it makes one eye look straight ahead while the
other eye turns inward and i can do that to the other side too i can switch to the other eye and
then i just let it go and relax and i'm back to having my regular focus now of course if you have
strabismus yourself this isn't going to work but if you just have normal vision and you're watching
this just learn then maybe you can give it a try it's kind of fun now with today's video all being
about strip business i do strongly encourage you to check out my video on amblyopia because they
are very much tied together uh they can occur independently for different reasons but again
they do have a lot a lot of relationship together so to check out that video click or tap the screen
up here to the side again thanks for watching keep an eye on it and we'll talk to you soon