Patient's question:
Intermittent exotropia of age, possibly genetic. Which hospital is the best for treatment in Shanghai? What is the success rate of surgery? What are the costs? Current general condition: Mostly normal, but exotropia occurs when attention is not concentrated, and it also occurs when exposed to strong sunlight.Doctor's answer:
Forming Factors or Etiology: Congenital + Genetic. Due to eye muscle problems, corrective surgery must be performed before the eyes stabilize, and the earlier, the better!Early Treatment for Pediatric Strabismus
An position of the eyes is called strabismus. In common perception, strabismus is an eye disease that affects beauty, but in reality, it is a common eye disease that severely affects visual function. So, how does strabismus affect visual function?
Under normal circumstances, when the eyes focus straight ahead, the axes of both eyes are parallel, and external objects form clear images on the fovea of the retina in each eye, which are then transmitted to the visual center of the brain. In the center, the images from both eyes fuse into a complete, stereoscopic overlapping image, forming the function of binocular vision (stereoscopic vision), which is one of human visual functions.
The formation and maintenance of binocular vision require not only good vision but also coordinated eye movements controlled by nerves and muscles, as well as complete fusion function. Any abnormality in any of these links to a certain extent may cause an imbalance in the ocular axes, leading to eye position deviation,.
Strabismus is divided into two types: paralytic strabismus and convergent strabismus. Strabismus caused by nerve palsy and muscle damage, accompanied by eye movement disorders, is called paralytic strabismus. Clinically, the more common type is non-paralytic strabismus, also known as convergent strabismus, with esotropia (commonly referred to as "crossed eyes") and exotropia (commonly referred to as "lazy eyes") being the most frequent.
Convergent strabismus is mostly related to refractive errors, refractive anisometropia, and imbalance in convergence and abduction functions, and it is particularly common in children. Some cases have a family genetic tendency.
Many parents believe that strabismus is caused by fever, or that it results from children staring at a certain direction for too long. In fact, esotropia is more common in infants and preschool children, with about 80% suffering from hyperopia. Hyperopic patients require more accommodation to see clearly, either far or near, which leads to excessive convergence and causes esotropia. Initially, it may only appear occasionally, making it intermittent, but it later develops into a constant condition.
Conversely, exotropia in children is less common, and the onset age is slightly older. The causes are mostly myopia. Myopic patients have less accommodation than normal eyes when focusing on near or far objects, resulting in insufficient convergence reflex and causing exotropia. Additionally, it is important to note that sometimes diseases within one eye (where the external appearance may be completely normal) can severely reduce vision in that eye (e.g., intraocular tumors, retinal diseases), initially presenting as exotropia.
Furthermore, incomplete fusion function is also a factor in the development of strabismus.
Strabismus can occur in one eye or alternate between both eyes. Strabismus in one eye has a greater impact on vision; when it occurs in both eyes, the vision of both eyes is often balanced.
Strabismus significantly affects appearance and often impacts a child's psychological development. However, what is more important is that the deviated eye's vision declines, leading to amblyopia and the loss of binocular vision. Therefore, the treatment of strabismus not only involves correcting the eye position but also more importantly, preventing and treating amblyopia to restore binocular vision. This is particularly crucial for children under 12. If this optimal treatment window is missed, by the time they become adults, strabismus correction can only restore appearance, but visual function cannot be restored. Thus, we emphasize that pediatric strabismus must be treated early.