1. STRABISMUS

6. Misalignment of the eye(s) may turn in, out, up, or down can be present in one or both eyes cross-eyed, squint. Vergence Duction

7. RISK FACTORS family history— if relatives have strabismus, a person is more likely to develop it refractive errors—extreme farsightedness (hyperopia) can develop strabismus due to the amount of eye focusing necessary to keep vision clear medical conditions—people with Down syndrome or cerebral palsy and people who have suffered a stroke or head injury are at higher risk for developing strabismus

8. TYPES OF STRABISMUS Esotropia—inward turning of the eye Exotropia—outward turning of the eye Hypertropia—upward turning of the eye Hypotropia—downward turning of the eye

9. ESOTROPIA The left eye is turned inward—note that the light reflection in the eyes is not symmetric

10. EXOTROPIA The right eye is turned outward—again, not the light reflection in the eyes is not symmetrical

11. HYPERTROPIA The right eye is turned upward—light reflection not symmetrical

12. HYPOTROPIA The right eye is turned downward-light reflection in eyes is not symmetric

13. ADDITIONAL CLASSIFICATIONS Constant or Intermittent Bilateral or Unilateral Congenital or Acquired Commitant(non-paralytic) or non-Commitant (Paralytic) Alternating or Fixed

14. Accommodative Non accommodative

15. Partially accommodative

17. Infantile Esotropia

18. WHEN DOES IT OCCUR? Congenital—developing during infancy; 50% of children with strabismus are born with it  Congenital Infantile Esotropia : Large angel of deviation, occurs before 6months of age Acquired—developing in adulthood; can also develop as a result of lack of treatment during childhood

19. Essential Evaluation 1.Age of onset 2.Visual acuity 3.Refraction 4.Ocular movements 5.(Vergence & Duction) 6.Angel of deviation 7.(commitance &measurement) 8.Eye health exam.

20. TREATMENT Eye Patch The stronger eye is patched to force the brain to interpret images from the strabismic eye. Eye patches will not change the angle of the strabismus. Typically, eye patching is used only if amblyopia is present. Never over patch.

21. Eyeglass or Contacts Eyeglasses or Contacts are used to improved the positioning of the eye(s) by modifying the patient’s reaction to focus. Eyeglasses and Contacts can also redirect the line of sight, which can help straighten the eye.

22. Eye Surgery Surgery may be necessary in an attempt to align the eyes by modifying one or more muscles in the eye. During surgery, the muscle positions will be changed or the length of the muscles will be changed. Surgery may follow a period of eye patching and then eyeglasses may be used after surgery to help treat strabismus. Surgery on medial rectus muscle of the left eye.

23. Botox Therapy Used as an alternative to eye muscle surgery. The idea is that the drug will temporarily relax the eye muscle, which will allow the opposite eye to tighten and straighten. The effects are short- term—about 3 weeks. Eye muscle exercises and eyeglasses may also be used to help strengthen the eye.