Strabismus (Vesguice): what is it, types, surgery, is there a cure?

What is strabismus?

Strabismus is the misalignment of the eyes, popularly known as vesgueira or vesguice. It can occur in just one or both eyes and be constant or intermittent. In addition, it is divided into six different types, according to the characteristics of the deviation.

In general, patients with strabismus may suffer psychological, social and economic problems due to their appearance being different. In most cases, it is more affected by children, but it also affects adults.

Following the international classification of diseases, it has the ICD-10 code H49 and H50.

What are their types?

Strabismus can be divided into six types, defined by the direction of the eye. Are they:

Convergent (esotropia)

When the affected eye is turned towards the center of the face, that is, turned towards the nose.

Divergent (exotropia)

The ocular deviation is turned towards the external part of the face, that is, towards the ear.

Vertical (hypertropias)

The eye is directed to the lower part of the face (cheek), or to the upper part of the face (forehead).

Alternating or intermittent

In this case, the deviation takes turns from one eye to the other. At a given moment, it is in the right eye, in another, in the left. Alternating strabismus is more common in cases of people affected by divergent strabismus.

Latent

It is only possible to check with clinical tests, as the symptoms do not manifest themselves clearly, being more related to pain, burning eyes or blurred vision.

Pseudoestrabismo

Factors of functional or anatomical orders give the sensation of a deviation of the eyes. This condition can be caused by pre-existing diseases, genetic factors, traumas and other factors. Its treatment has several alternatives, surgical or not.

It is also worth remembering that there may be a combination of types of strabismus, for example, convergent / vertical, in which the eye is turned towards the inside of the face and upwards.

In children up to six months of age, temporary strabismus may occur, due to the child’s muscle formation not being complete. This picture is quite fleeting for this age group.

How Eye Movements Work

Eye movements are performed by six muscles, located on the face, which need to work in harmony when they receive commands from the cranial nerves, which are connected to the central nervous system.

What causes strabismus?

Strabismus occurs with the imbalance of this harmony, in which the muscles do not work synchronously with each other. Motor coordination problems in these muscles can be considered as influencing factors of disharmony.

Studies show that strabismus can be a family disease. However, several patients do not have a positive family history for the disease. Some pre-existing diseases can also cause strabismus such as:

  • Neurological diseases;
  • Stroke;
  • Down syndrome;
  • Brain tumors;
  • Diabetes;
  • Congenital cataract;
  • Hyperopia or the low vision of one eye, which forces the eyes closer to facilitate the visualization of objects or people;
  • Thyroid changes;
  • Genetic factors;
  • Head and facial trauma;
  • Meningitis;
  • Encephalitis.

Unlike urban legend, forcing squint does not cause squint.

And the symptoms?

Symptoms vary widely according to the age at which the disease is manifested. When it occurs in childhood, the main symptom, which is duplicated vision, does not occur.

  • Double vision is always present when strabismus manifests itself in children of older age groups, in the range of 6 years of age, or in adults;
  • Torticollis;
  • Headache.

Identifying strabismus in children

Up to approximately six months of age, the facial movements may be uncoordinated, as it is linked to the body’s muscle formation. This process gives the sensation of strabismus, known as pseudoestrabismus, which must be monitored, as it may or may not be an alarming strabismus.

Due to the fact that children often do not know how to express themselves, it is worth noting some habits that may be indicative of strabismus, such as:

  • Bend the head to see;
  • Close an eye on the clarity;
  • Constantly blinking.

When to see a doctor?

If strabismus is suspected, it is important to consult a doctor so that he can perform tests and can give a more accurate diagnosis.

Why don’t younger children suffer from double vision?

Duplicate vision is not manifested in these cases, due to a system developed by the brain that discards the image formed by the affected eye, which can lead to amblyopia (temporary or permanent loss of vision in the affected eye). In order to prevent this process from occurring, it is recommended to start the logos treatment after diagnosis.

How is strabismus diagnosed?

Only the observation of the alignment of the eyes can be indicative. In addition to this, there are several tests performed by an ophthalmologist that can reach the diagnosis, such as:

Fundus examination

With the aid of an ophthalmoscope, the doctor projects a beam of light into the eye and, with the reflection of this light in the retina, it is possible to observe its structures, analyze them and obtain a more accurate diagnosis.

There is no age restriction for this procedure.

Visual acuity

This test helps to define the patient’s visual prognosis, analyzing the ability to perceive the shape and outline of objects (hyperopia), which is one of the causes of strabismus. It must be performed by an ophthalmologist.

Reflex test

The procedure consists of the perception of the red reflection that appears when a beam of light is directed under the retinal surface. The test is performed with the aid of a direct ophthalmoscope. It is a diagnostic test for several eye problems that can trigger strabismus.

Occlusion test

In general, this test is performed in cases of myopia and consists of covering one eye, thus forcing the deviated eye to move forward, temporarily restoring visual function. It is performed in an office, by an ophthalmologist.

After the tests are completed, a referral to the strabologist ophthalmologist, who is the specialist for this condition, can be referred.

Is strabismus curable? What is the treatment?

This is a problem that can be cured, however, there is no spontaneous disappearance of the disease and it is a mistake to think that the problem can regress without interventions. For this reason, the sooner your treatment is started, the better the results will be. Currently, there are several treatment alternatives depending on the patient’s age.

Eye plug

This alternative is more common for patients up to 3 years of age, and can be applied to other ages.

The use of the eye protector occurs in the eye without deviation for a daily period of 3 to 6 hours or even throughout the day, varying according to the misalignment. Its purpose is to force the alignment of the eye affected by the strabismus with the unaffected eye and to prevent the brain from discarding the image formed by the misaligned eye.

This eye protector is found for sale in pharmacies.

Eye exercises

As a more practical alternative and, according to experts, with faster results according to the level of strabismus, this is a very considerable alternative.

These exercises aim to strengthen the eye muscles and eliminate the problem.

It is worth mentioning that these exercises must be accompanied by an orthopedic doctor.

Botulinum toxin

Botulinum toxin, a neurotoxin produced by the bacterium Bacilo clostridium botulinum, better known as Botox , is a less aggressive alternative, which reduces recovery time.

The procedure lasts for about a minute and consists of application directly to the muscle, causing the blockage of nerve impulses in the region, thus having, as a consequence, the alignment of the eyes.

The application is performed with local anesthesia, does not alter the facial anatomy and can also be performed in children. It is more suitable for milder cases, or post surgical.

Medical evaluation should always be taken into account.

Wearing glasses

With the indication of an ophthalmologist, the glasses aim to reduce the effort to focus the observed image and, consequently, to straighten the eyes, being indicated as the only alternative or in association with other treatments.

Surgical intervention

Corrective strabismus surgery is best indicated when the previous alternatives do not respond satisfactorily or in more extreme cases.

The procedure consists of repositioning or shortening the eye muscle through micro incisions. It lasts approximately two hours and can be performed under local or general anesthesia, which will be defined by the doctor. The patient can be discharged on the same day.

The vision may be temporarily blurred, due to the need for the body to readjust, so it is normal to present this symptom in the first two weeks after the intervention.

Postoperative

The recovery period is relatively short, as the incisions are not considered aggressive. This process takes around one to two weeks. The points are internal and absorbed by the organism, a fact that does not need to be removed.

Some care is passed to the patient, which are:

  • Performing cold compresses in the first 24 hours, with crushed ice in a plastic bag wrapped in a cloth, for 20 minutes every 4 hours, helps to reduce pain and swelling.
  • Do not use a handkerchief to dry possible tearing (if necessary, use a gauze and discard it after use);
  •  Use sunglasses if the sun is bothering you;
  • Clean the operated eye with saline or boric water, if necessary;
  • Rest for a week and avoid contact sports for another seven days.

Read more: What is boric acid?

Living with strabismus

In addition to double vision, what most bothers patients with strabismus, in most cases, is low self-esteem due to their physical image, especially in adolescent patients. If the patient deems it necessary, one can have the assistance of a psychotherapist and support groups.

Prevention

As it is predominant in children, the best prevention against strabismus is to observe and perform the follow-up by the ophthalmologist since birth. The visual function and its development will be determined in the first months of a child’s life.

A child with strabismus, whether evident or not, treated early, will have a better prognosis. This early diagnosis makes it possible to assess which causes are associated, to avoid or treat amblyopia (loss of affected vision) and to investigate possible pathologies that may be causing the problem.

The control and monitoring must be constant until adolescence, and the patient must actively participate in the treatment, with strict compliance with all the steps passed by the doctor.

Complications

Although there are few complications related to strabismus, the most common are:

Depression and low self-esteem

Due to aesthetic discomfort and not having a “standard” appearance, it is common for these two conditions to manifest in these people simultaneously or not. Other factors that can influence the manifestation are social acceptance and bullying.

One must have a diagnosis and psychological monitoring to treat them, because, in general, many people have tendencies of isolation and difficulty in developing interpersonal relationships, which hinders the improvement of the condition without monitoring.

Vision loss

The most serious complication is the risk of loss of vision, which usually occurs when the patient is of a younger age, however, it is not exclusive to babies and children, and can occur at all stages of life.

Below, some vision loss processes will be described, which may be total or partial.

Vision loss in children

Due to the fact that the brain discards the image formed by the affected eye (amblyopia), children are more at risk of losing their three-dimensional vision (ability to perceive the depth and / or distance of objects).

With the high frequency of amblyopia, the brain “creates the habit” of discarding the image and gradually makes this process common, reaching a point where it no longer recognizes the image formed by the affected side.

The risk can be greater when strabismus is of the alternating type, in which, with the alternation of the affected eye, loss of vision in both eyes can occur.

Vision loss in adults

When the images captured by the eyes reach the brain incorrectly, the main consequence is the loss of notions of depth and distance, as well as a reduction in the total angulation of the natural field of view. Such conditions often cause people to stumble, for example.


Strabismus is quite common, however, with early diagnosis and treatment, its duration is shorter and brings better results. Thus, without surgical intervention, the risk of other complications is reduced, guaranteeing the patient a normal life.

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