Different types of strabismus have different causes, occur at different ages, and have different effects on visual development, so the timing of treatment and treatment methods are different and need to be treated differently.
1. Congenital internal strabismus.
The onset of the disease is early, within 6 months after birth, and the strabismus cannot be corrected by glasses, which has a great impact on the development of binocular vision of the child; since the critical period of children’s visual development is before the age of 2-3 years, surgery should be performed before the age of 2 years as far as possible to provide the necessary conditions for the development of binocular vision.
2. Refractive Adjustable Internal Strabismus.
The onset of strabismus is later than that of congenital internal strabismus, and refractive error is the complete cause of strabismus; the strabismus can be eliminated by wearing suitable corrective glasses to keep the eye in the right position; timely and correct prescription can not only correct the strabismus, but also the development of children’s vision will not be affected; therefore, surgery is not necessary. It is necessary to go to a regular pediatric ophthalmology institution for timely and correct prescription and insist on timely adjustment of the prescription.
3. Partially adjusted internal strabismus.
The onset of strabismus and refractive error are partially causally related. Wearing sufficient corrective glasses can reduce strabismus but cannot make it disappear; residual strabismus will still affect the development of binocular vision in children, and the possibility of abnormal retinal correspondence increases due to the smaller degree of internal strabismus after wearing glasses, so surgery is needed as soon as possible to correct the residual strabismus after wearing glasses under the premise of clear diagnosis. It should be reminded that because the strabismus becomes smaller after wearing glasses, parents may ignore it and delay the surgery, resulting in stubborn abnormal retinal correspondence and strabismic amblyopia.
4.Non-refractive adjustable internal strabismus.
The onset of strabismus is caused by the abnormal ratio of regulation and collection. The normal amount of regulation when looking at the near will produce too much collection, which is manifested in the inward strabismus when looking at the near and normal eye position when looking at the far; even if there is refractive abnormality, there is still inward strabismus when looking at the near after wearing reasonable corrective glasses; You can wear bifocal glasses, progressive multifocal glasses, and medication (pilocarpine) to improve the tension of the ciliary muscle to reduce the adjustment stimulus when looking at the near, etc. to reduce the collection of looking at the near.
5. Non-adjusted internal strabismus.
The onset of strabismus is not related to the refractive state, even if there is refractive error, the degree of distant and near strabismus will not be reduced after wearing glasses; wearing glasses can not correct this type of strabismus, need timely surgery to solve.
6, congenital exotropia.
The onset of strabismus is early, not closely related to refraction, cannot be corrected by glasses, and the degree of strabismus is constant and cannot be controlled by the brain at any time. This type of strabismus has a greater impact on the development of binocular vision and requires early surgery, preferably before the age of 2, in order to provide the necessary conditions for the development of binocular vision.
7. Intermittent exotropia.
The onset of strabismus is before the age of 5 years, due to the defective central visual reflexes on the control mechanism of both eyes. Strabismus appears intermittently, easily appearing when fatigued, distracted, looking away or under the sun; due to the different ages of onset, the chance of strabismus appearing varies, with different effects on binocular vision; surgery is generally needed, but the timing of surgery should be flexible according to the different conditions of the patient. The principle is to operate as early as possible with the cooperation of the child to protect the visual function of both eyes from being damaged; if the visual function examination of both eyes reveals visual inhibition, surgery should be performed as soon as possible in order to lift the inhibition and restore the visual function of both eyes; after surgery, training of visual function of both eyes should be performed to enhance the ability of central control of strabismus.
8. Congenital paralytic strabismus.
It exists after birth and is usually detected within one year of age. Some children have compensatory head position (skewed head), which even causes asymmetry of facial development and curvature of the spine; the treatment of such strabismus is to operate as early as possible under the premise of clear diagnosis to correct the patient’s head position so as not to cause or aggravate the asymmetry of facial development and curvature deformity of the spine.
9. Acquired paralytic strabismus.
Adult onset, can be caused by head trauma, tumor or hemorrhage compression, degeneration or infection of cerebral nerve, endocrine or toxic diseases, etc., causing the attack of the talocrural nerve or motoneurotic nerve or abducens nerve; resulting in eye movement disorder to produce paralytic strabismus; symptoms of diplopia or confusion; the principle of treatment is active etiological treatment to promote the recovery of nerve function; in the second half to one year under the premise of etiological treatment, if If the nerve function is not restored and the strabismus still exists, surgery is required to correct the eye position and eliminate diplopia and confusion.
10. Other special types of strabismus.
Such as thyroid-related ophthalmopathy, vertical detached strabismus (DVD), ocular regression syndrome, extensive fibrosis of extraocular muscles, etc. need to be determined according to the degree of strabismus, the state of visual function of both eyes and the impact on the patient.
In short, different types of strabismus have different treatment methods and timing of surgery, which need to be treated differently by doctors; moderate internal strabismus can be treated with appropriate glasses in time and does not require surgery; partial moderate internal strabismus requires both glasses and surgery in time to correct the residual strabismus; other than that, almost all strabismus requires surgery, and in principle, surgery is required as early as possible.