A. Is it strabismus for a child to watch TV with a tilted head? It is not necessarily strabismus for a child to watch TV with a tilted head. Parents regard their children’s tilted head as “strabismus”. Crooked head can be divided into ocular strabismus, anatomical strabismus and lateralismus. Causes of ocular strabismus include strabismus, nystagmus, and refractive errors (mainly greater astigmatism). Patients with strabismus, nystagmus, and greater astigmatism can acquire binocular monocularity by tilting the head and turning the face, and will then exhibit tilted head vision. Anatomical squint, also known as surgical squint, is mainly caused by congenital abnormal development of neck muscles; after excluding ophthalmic squint and anatomical squint, it is possible that the child’s crooked head is the so-called “lateral vision”, which is related to the child’s psychological habits and can be corrected by parents as long as they find it. The ophthalmic and surgical strabismus should be treated in the corresponding specialized department. Strabismus is caused by the separation of the visual axes of both eyes and the inability of both eyes to look at the same object at the same time. Strabismus in childhood can damage the monocular function of both eyes and even affect the development of vision. Parents should take their children to the hospital for an early checkup when they discover strabismus. If there are refractive errors, such as farsightedness, myopia, astigmatism, they should be corrected with glasses; if amblyopia is found, it should be actively treated first. For congenital strabismus and constant strabismus, early surgery should be performed to help the child establish binocular monovision; occasional intermittent exotropia or adjusted internal strabismus that can be corrected by wearing glasses can be temporarily observed when it does not affect binocular vision function, and regular visits to the hospital should be made to take appropriate treatment according to changes in the condition. When is the best time to do strabismus correction surgery First of all, the cause of strabismus should be clarified, except for malignant lesions, such as intracranial occupying lesions, infections, immune diseases, etc. Children with refractive error should first be treated for refractive error, and those with combined amblyopia should first be treated for amblyopia. The timing of strabismus correction surgery is related to the type of strabismus, binocular vision function and age of the child, and should be treated under the guidance of a physician. Some children have double vision after strabismus correction surgery. After strabismus correction surgery, especially in the early postoperative period, due to eye pain, mild movement restriction and unstable eye position, some children may have double vision. If the hyperopia persists for a longer period of time (usually more than half a month or two months), the child should be seen by a physician and treated accordingly. For children with strabismus and amblyopia, the general principle is to treat the amblyopia first and then perform strabismus correction surgery, which is conducive to the stability of the postoperative eye position of both eyes. However, there are some exceptions, for some restrictive strabismic amblyopia, surgery can also be performed first to treat the strabismus, so that the eyes are parallel and the mutual interference caused by the strabismus can be removed, providing the necessary foundation for the treatment of amblyopia. Although the need for hospitalization varies according to the general health condition and the operator’s preference, surgery to correct eye position is usually an outpatient procedure. You can go home after surgery or stay overnight in the hospital. This arrangement facilitates the anesthesiologist to help us with supervised anesthesia. After surgery, most patients resume all normal activities within a few days. Is it normal for a thread to fall out of the eye a few days after strabismus surgery? Modern strabismus correction surgery is performed with absorbable sutures, which do not need to be removed after surgery. The conjunctiva can be sutured or not, if sutured, the sutures generally fall off on their own in 1 to 2 weeks, and even if they do not fall off, they can be absorbed on their own, and absorption generally starts gradually after a month. If there is still a feeling of eye grinding one week after surgery, the sutures can be removed. Pseudo-internal strabismus Because of the wide nasal bridge, inner canthus and small pupil distance, the eyes look inwardly skewed in appearance, but in fact, the eyes of the child have parallel visual axes and are not skewed. Pseudo-internal strabismus is not a true strabismus and does not require treatment, and generally improves in appearance as the face develops. However, even if a child has pseudo-intraocular strabismus, parents should still insist on routine pediatric eye exams every six months to a year. The causes of pseudo-internal strabismus are a wide nasal bridge, inner canthus, and small pupillary distance in infants and children. Pseudo-vertical strabismus can be formed by ptosis and receding lower lids. Pseudo-exotropia is seen in positive kappa angles, or wide pupillary distance can also cause exotropia artifacts. Some fundus lesions, such as retinopathy of prematurity, can pull the macula toward the temporal side, resulting in positive Kappa angle, and such patients should have further dilated pupils to check the fundus. The best age for correction of congenital internal strabismus is a few years old. Internal strabismus that appears within 6 months after birth is called congenital internal strabismus, also known as infantile internal strabismus. In addition to internal strabismus, it is also often combined with hypermetropia, vertical detached strabismus, occult nystagmus and other symptoms, so it is also called congenital internal strabismus syndrome. Children with congenital internal strabismus usually have alternate binocular gaze and no binocular visual function. Early surgery is advocated for congenital internal strabismus.