Conservative versus surgical treatment of strabismus in children

  Conservative treatment 1, refractive correction, some patients with internal strabismus at the same time there is a high degree of hyperopia, due to hyperopia eye regulation, convergence caused by excessive adjustment of the adjustment of the internal strabismus, wearing glasses can make all the correction of strabismus. This type of internal strabismus is called complete refractive regulating internal strabismus, and the key point of its treatment is to use atropine to dilate the pupil, and to correct the hyperopia in full when dispensing glasses. In addition, some refractive strabismus can not be completely corrected with glasses, but it is also necessary to standardize the preoperative optometry and prescription, otherwise it may lead to overcorrection of the internal strabismus. In addition, for combined astigmatism, whether internal strabismus or exotropia, should also be the first prescription lens treatment.  2, treatment of amblyopia, strabismus patients often combined with amblyopia, especially the internal strabismus, before considering surgery to correct strabismus, must first cure the amblyopia, otherwise not only is not conducive to the establishment of stereo vision after surgery, but also not conducive to long-term eye position after strabismus.  3, orthophoria training, if it is a small angle strabismus, and at the same time both eyes monovision function is relatively good, such as small angle exotropia, can be trained to maintain the strabismus angle for many years no longer progress.  4.Wearing trigonometry. According to the law of object displacement and the size of strabismus, trigonometry is placed in front of the strabismic eye, so that both eyes have a common visual direction, which can make the monocular function of both eyes develop. It is mainly used for: small angle strabismus; residual strabismus position after strabismus surgery; and the transition of younger children with strabismus before surgery. However, this method does not have a curative effect on most strabismus.  The best time for strabismus surgery Generally speaking, if common strabismus in children is not treated in time, they may lose the visual function of both eyes after the age of 12, and even if the strabismus is solved by surgery after this age, it will only have a cosmetic effect. Therefore, strabismus should be treated promptly. For non-common strabismus, the timing of surgery is usually six months after the onset of the disease. The most common type of strabismus in children is common strabismus. The timing of surgery is mainly considered in the following aspects: first, the younger the age of onset, the more important it is to operate early, second, the more frequently the strabismus appears, the more important it is to operate early, and third, the longer the duration of strabismus after its appearance, the more important it is to operate early.  The timing of surgery for several common strabismus 1. Congenital strabismus must be operated early. The child’s binocular vision is usually formed before the age of 5. If the child is suffering from strabismus during the period of visual development, both eyes cannot look at the same target at the same time, so there is no way to talk about the development of binocular vision, and if it is not corrected in time, eventually the child’s binocular vision will not be able to develop normally and lead to stereopsis.  2, combined with amblyopia strabismus. Generally speaking, amblyopia correction is given priority, and surgery is performed after the amblyopia is cured to treat strabismus.  3. For intermittent exotropia, if the degree of strabismus is low and the strabismus is usually not visible, the change in the degree of strabismus can be observed on the basis of checking the visual function of both eyes. For those who have more frequent episodes of intermittent exotropia, especially those who have a tendency to deteriorate the monocular function of both eyes, they should undergo surgery as soon as possible, if they are allowed to develop, the effect of surgery will not be good after the loss of function.  4. For children with internal strabismus, if the angle of deviation is large, surgery should be performed as soon as possible if the amblyopia is cured. However, we should pay attention to the standardized optometry to see whether the combination of high and medium hyperopia, if combined even if the vision is normal, you should wear glasses for at least 3 months.