Definition of strabismus Strabismus, commonly known as “crossed eyes” or “crossed eyes,” is a very common eye disorder. It can affect people of all ages, with a prevalence of about 1% in children. The term “cross-eyed” or “cross-eyed” only describes one type of strabismus, internal strabismus, which is characterized by one eye being normal and the other eye being squinted inward, so that the two eyes appear to be close together or “This type of strabismus is characterized by one eye being normal and the other eye being squinted inward. Another common type of strabismus is when one eye is normal and the other eye is deviated outward, i.e., exotropia, and upward strabismus. The onset of strabismus is mostly in childhood, with the early onset becoming more apparent even a few months after birth, and the later onset becoming more apparent at the age of 7-8 or around 20 years. The manifestation of strabismus varies widely, with some strabismus showing frequent strabismus and large angles at the onset, while others appear only occasionally, sometimes with large angles and sometimes with small angles. There are many ways to treat strabismus, some can be cured by wearing glasses, but some need surgery, and the earlier the age of surgery, the better, the following are a few common problems in strabismus treatment: Can wearing glasses cure strabismus? There is a kind of internal strabismus, the onset of which is caused by hyperopia, so it can be corrected by wearing the right glasses. We refer to this type of strabismus as a fully refractive accommodative strabismus. The main point of treatment is to use atropine eye ointment to fully dilate the pupil during the eye exam, 3 times a day for 3 days, sometimes 5 days. The farsightedness must be checked accurately, and the glasses must be fully prescription. In other words, the glasses should be of the right size for the degree of farsightedness detected. It is important to note that this type of strabismus does not disappear immediately after wearing glasses, most of them can disappear slowly only after 3-6 months of wearing glasses, and the farsightedness gradually becomes smaller with age, when it is small to a certain extent. When the strabismus does not appear even after the glasses are removed, the glasses can be completely removed. And this type of strabismus must not be treated surgically. If the strabismus is a small degree combined with myopia, the angle of the strabismus will be significantly smaller or even become exotropia after wearing myopia glasses, and if the strabismus is a larger degree, most of them need surgery. Why some children need early surgery for strabismus The main purpose of early surgery for children with strabismus is to create conditions for the development of binocular monovision, not just to look good, binocular monovision is commonly known as stereopsis or depth perception, how to experience what is stereopsis? We can cover one eye to try going up and down the stairs, then you will find a kind of stumbling, deep and shallow feeling. Patients with strabismus, although there is no which eye is covered, but one eye strabismus, two eyes can not look at the same target, equivalent to strabismus eye “covered”, its visual effect is the same as one eye is covered. The most important condition for the development of stereopsis is the parallelism of the visual axis of both eyes, that is, the absence of strabismus, especially in the early postnatal period or in early childhood, to maintain the parallelism of the visual axis of both eyes. The most common clinical condition is congenital internal strabismus, that is, internal strabismus that develops after birth or within 6 months after birth, and congenital exotropia that develops within 1 year after birth, the former should be operated before 2 years old. In the case of congenital exotropia, as long as the child has the opportunity to look at both eyes monocularly, that is, when there is no eye strabismus, by no strabismus we mean that there is the opportunity to look at the target with both eyes at the same time, that is, neither eye is strabismic. Some children with exotropia only have occasional episodes of strabismus, so surgery may not be considered for the time being. However, for those children who have exotropia that frequently fails to maintain an upright position at the onset, surgery should be performed as early as possible, usually before the age of 2-3 years. The difficulty of early surgery in children with strabismus is that it is difficult to measure the degree of strabismus, i.e., the strabismus angle, at this age, and accurate strabismus angle measurement is the key to successful surgery. Another difficulty with strabismus surgery in children is that the surgery must be designed with long-term foresight, from a developmental point of view, not just considering only the immediate results after surgery. Is strabismus surgery safe and what are the sequelae? Strabismus surgery, also known as extraocular muscle surgery, is a surgical procedure that shifts the position of the muscles attached to the surface of the eye that control the movement of the eye, thus changing the tension of the muscles to adjust the position of the eye (from strabismus to orthotropia). It is the earliest of all eye surgeries, with a history of 150 years, and the safest. The procedure does not open the eye, so it does not affect vision, and the day after surgery, you can open the cover and see normally. It can be considered the safest of all eye surgeries. Traditionally, the incision for strabismus surgery is made at the corneal limbus, the area where the black and white eyes meet, and some patients are left with scars in this area after surgery, which affects their appearance. In most modern strabismus surgery, the incision is made at the conjunctiva of the dome, which is the conjunctiva at the back of the eyelid. The length of the incision is small, so that even if a small scar is left after surgery, it is not visible because the eyelid is covered, and with this type of surgery, recovery is quick, requiring only a day of rest with the eye covered on the day of surgery, and no longer requiring a cover the day after surgery. General anesthesia is generally chosen for children’s strabismus surgery, which is commonly known as the use of drugs to make the patient temporarily lose consciousness and pain during the surgery and wake up soon afterwards. In recent years, the technology of general anesthesia has progressed very fast, especially the development of monitoring instruments, basically to what extent you want to be anesthetized to what extent you can wake up at any time you want. And the drugs used are quickly metabolized by the body, and will not be harmful to the body. As for the impact on the child’s intelligence has never been no scientific basis, it is just a pretext for the former professionals on general anesthesia is not sure and a misunderstanding of the people! Now in Europe and the United States and other developed countries, sometimes the extraction of teeth and other minor outpatient procedures also use general anesthesia. Now in our country, some of the higher medical level of large hospitals, for adult strabismus surgery, also often use general anesthesia, so that the patient will not have any pain and fear during the entire operation. However, there is a higher requirement for the surgeon’s surgical level because during the local anesthesia surgery, the patient is fully conscious and the surgeon can make adjustments while doing so until the surgery is satisfactory. However, this kind of orthostasis on the operating table is actually unreliable, because most patients undergoing surgery on the operating table are mentally tense, and when they are relaxed after surgery, they are not necessarily orthostatic, and the muscle tension during surgery is different from the normal physiological state due to bleeding and pulling. Is it difficult to take care of strabismus surgery in young children? Many parents worry that if a 2-3 year old child wraps his eyes with gauze after surgery and cries or scratches his eyes, will it affect the surgical result? It is true that most young children will be very upset for 3-4 hours after surgery, but after a few hours, most of them will calm down after being persuaded by parents and medical staff. There are also cases where the gauze is scratched off, but the eye will not be damaged.