The causes and types of strabismus in children are different, and the treatment methods are different.
1. Different treatment methods are used according to the degree of strabismus in children
(1) Treatment of occult strabismus
Generally speaking, children have strong fusion and convergence ability, and although they have cryptotropia, they are mostly asymptomatic and can be treated without any treatment. Some children suffering from occluded strabismus have painful eye swelling and orbital pain after reading and writing at close range, even accompanied by headache and other symptoms of visual fatigue, so they should be treated appropriately. For those who have hyperopia, they should wear glasses with appropriate distance vision, especially when they look close. The method is to take a pencil tip and place it 30 cm in front of the eyes, stare at the pencil tip with both eyes and gradually bring the pencil tip closer to the eyes, then the eyes will strengthen the convergence and turn inward, continue to move the pencil tip to both eyes until the eyes have a double image, so repeatedly, this training is insisted on 5-10 minutes each time, 1-3 times a day, in order to strengthen the strength of the internal rotation muscle of both eyes to overcome If the effect is not satisfactory, surgery can be considered for external strabismus that is greater than 10 units.
(2) Treatment of intermittent strabismus
Intermittent internal strabismus is mostly caused by hyperopia, once found, the child should be immediately taken to the hospital for dilated pupil examination. According to the degree of hyperopia, the doctor can provide sufficient amount of hyperopic glasses to correct the intermittent internal strabismus and prevent it from developing into dominant internal strabismus.
Children with intermittent exotropia should first undergo strabismus measurement and synoptic examination to understand the degree of exotropia and the visual function of both eyes, and then undergo surgery as early as possible before the loss of visual function of both eyes. If the visual function of both eyes is lost, there is still a possibility of recovery before the age of 7. For those with very small strabismus, they can try to wear myopic glasses and pencil vergence training, but this can only reduce the strabismus and is not easy to cure completely.
(3) Treatment of dominant strabismus
Except for the adjustable internal strabismus, early surgery is needed.
2. Different treatment methods are used according to different causes of strabismus
(1) Treatment of common strabismus
Treatment of dominant strabismus
(1) Treatment of congenital internal strabismus is mostly unrelated to eye regulation, but it has a great impact on the development of binocular visual function and cannot be corrected by non-surgical treatment such as wearing glasses, so the best treatment is to strive for surgical correction at the early stage of visual function development at the age of 2. If the strabismus is completely corrected, continue to wear the glasses, and if it is partially corrected, the residual internal strabismus will be treated surgically. If the internal strabismus does not change after wearing glasses, only surgery is available.
Treatment of dominant exotropia
If both eyes have good visual acuity, obvious refractive error can be ruled out, and the principle of treatment for this type of strabismus is also early surgery. Children with poor visual acuity should have a dilated eye exam, and if they are found to have moderate to high myopia, the exotropia may be caused by myopia that is often not adjusted, and they should wear appropriate myopic glasses, and the exotropia may be corrected. If the hyperopia is combined with amblyopia, the hyperopic glasses should be worn according to the lower degree of corrected best vision, and amblyopia training should be done at the same time.
(2) Treatment of paralytic strabismus
Paralytic strabismus in children is mostly caused by congenital developmental abnormalities, birth injuries and diseases within the first few months of life. If it appears after birth, it is mostly related to developmental abnormalities and birth injuries; if it appears within a few months after birth, it is mostly related to diseases, so the cause should be found first. In addition to taking a detailed medical history, the physician should request consultations with otorhinolaryngology, neurology, brain surgery, and pediatrics to rule out diseases such as periocular sinus, cerebral nerve, and intracerebral tumors, because in the early stages of many serious periocular and intracranial diseases, paralysis of the extraocular muscles can be manifested. This allows for proper diagnosis of the primary disease, preventing delayed treatment opportunities and malignant outcomes.
To treat paralytic strabismus, different methods are used depending on the strabismus and its degree.
Non-surgical treatment
In children with acquired paralytic strabismus, once detected, the cause of the disease is actively sought and treated with injections and oral vitamin B
In addition, physiotherapy and acupuncture can be used to promote the recovery of paralyzed muscles. It usually takes six months, and surgery is not considered after six months of recovery.
In children with mild paralytic strabismus, there is no strabismus and diplopia in frontal gaze, and there is monocularity in both eyes, and the compensatory head position is not obvious, and only when the eye turns to a certain direction there is diplopia.
Surgical treatment
Paralytic strabismus in children is mostly congenital and treatment is mainly surgical. Although moderate paralytic strabismus can overcome diplopia and maintain the development of binocular monovision by adopting a certain compensatory head position, it can lead to deformities of the face, neck and spine in the long run, so surgery should be done at the age of 2-3 years old to correct it, especially for severe strabismus.
Even if the binocular monovision is incompetent or completely lost, as long as the surgery is done early and properly, the postoperative eye position can be corrected, the compensatory head position will disappear soon and the binocular visual function will be restored soon to achieve the purpose of functional cure.