Strabismus

STRABISMUS
By: Esther Joanna J. Ricamara Student Nurse Institute of Nursing St. Josephs College of Quezon City
What is squint (strabismus)?

Squint is a misalignment of the two eyes so that both the eyes are not looking in the same direction. This misalignment may be constant, being present throughout the day, or it may appear sometimes and the rest of the time the eyes may be straight.( Intermittent)
It is a common condition among children. It may also occur in adults.
STRABISMUS
occurs when both eyes do not look at the same place at the same time; the eyes are unable to align properly under normal conditions eye(s) may turn in, out, up, or down can be present in one or both eyes often referred to as: cross-eyed, crossed eyes, cockeye, weak eye, wall-eyed, wandering eyes, and/or eye turn
Eye movement
CAUSES OF STRABISMUS
result of the lack of coordination between the muscles of the eye responsible for eye movement problems with the nerves that transmit information to the eye muscles problems with the control center in the brain that directs eye movement the lack of coordination prevents proper binocular vision and keeps both eyes from gazing at the same point in adults, can be caused by stroke, thyroid problems, brain injury, or other trauma which disrupts the ability of the eye muscles to work properly
TYPES OF STRABISMUS
Esotropiainward turning of the eye
Exotropiaoutward turning of the eye

Hypertropiaupward turning of the eye Hypotropiadownward turning of the eye
ESOTROPIA
The left eye is turned inwardnote that the light reflection in the eyes is not symmetric
EXOTROPIA
The right eye is turned outwardagain, not the light reflection in the eyes is not symmetrical
HYPERTROPIA
The right eye is turned upwardlight reflection not symmetrical
HYPOTROPIA
The right eye is turned downward-light reflection in eyes is not symmetric
PATHOPHYSIOLOGY
congenitaldeveloping during infancy; 50% of children with strabismus are born with it acquireddeveloping in adulthood; can also develop as a result of lack of treatment during childhood
RISK FACTORS
Family Historyif relatives have strabismus, a person is more likely to develop it Refractive Errorsextreme farsightedness (hyperopia) can develop strabismus due to the amount of eye focusing necessary to keep vision clear Medical Conditionspeople with Down syndrome or cerebral palsy and people who have suffered a stroke or head injury are at higher risk for developing strabismus
DEVELOPMENT IN INFANTS
a newborns eyes will typically move independently and even drift outward it is not normal for an infants eyes to cross constantly by 3 to 4 months old, an infant should be able to focus on objects and eyes should be straight, with no turning 30-50% of children with strabismus develop secondary vision loss (amblyopia) the onset of strabismus is most common in children at 18 months to 6 years old if a parent notices their childs eyes moving inward or outward, the eyes seem to be crossed, or the child is not focusing on objects, they should seek medical attention
DEVELOPMENT IN ADULTS
most likely to develop as a result of injury or disease adult will most likely experience double vision, eye fatigue, overlapped or blurred images, a pulling sensation around the eyes, difficulty with reading, and/or a loss of depth perception if loss of vision occurs, it is typically due to exotropia (eye turns outward) rather than amblyopia because vision is already developed in the adult brain and the adult brain will not compensate for deviation the way a childs brain will
DIAGNSTIC TEST
A comprehensive eye exam is necessary with focus on the following: patient historya comprehensive history is necessary to assess symptoms, health problems, and medications visual acuitymeasurements are taken to assess extent to which vision is affected refractionconducted to determine the lens power necessary to compensate for any refractive error alignment and focusingassessing how well your eyes focus, move, and work together eye health examassessing the structures of the eye (internal & external) to rule out possible disease
Cover tests
Cover test detects
heterotropia
Uncover test detects
Prism cover test measures total deviation
heterophoria Alternate cover test detects total deviation
Visual acuity tests in verbal children

At age 2 years (naming pictures)
Kay single picture
Multiple pictures
At age 3 years (matching tests)
Sheridan-Gardiner
Sonksen-Silver
TREATMENT
Eye Patch
The stronger eye is patched to force the brain to interpret images from the strabismic eye. Eye patches will not change the angle of the strabismus. Typically, eye patching is used only if amblyopia is present.
TREATMENT
Eyeglass or Contacts
Eyeglasses or Contacts are used to improved the positioning of the eye(s) by modifying the patients reaction to focus. Eyeglasses and Contacts can also redirect the line of sight, which can help straighten the eye.
TREATMENT
Prisms
Prisms are used to modify the way light and images hit the eye. The lenses provide comfort and can help prevent double vision from developing.
TREATMENT
Vision Therapy
A non-surgical method of therapy that treats the eye and the brain. An optometrist will oversee the therapy, which is designed to strengthen or develop visual skills. The optometrist may also use eyeglasses, prisms, eye patches and computerized medical devices during the therapy.
SURGICAL MANAGEMENT
Eye Surgery
Surgery may be necessary in an attempt to align the eyes by modifying one or more muscles in the eye. During surgery, the muscle positions will be changed or the length of the muscles will be changed. Surgery may follow a period of eye patching and then eyeglasses may be used after surgery to help treat strabismus.
Pre-surgery
Post-surgery
PHARMACOLOGICAL MANAGEMENT
Botox Therapy
Used as an alternative to eye muscle surgery. The idea is that the drug will temporarily relax the eye muscle, which will allow the opposite eye to tighten and straighten. The effects are shorttermabout 3 weeks. Eye muscle exercises and eyeglasses may also be used to help strengthen the eye.
TREATMENT
there is no cure for strabismus
with treatment, the effects of strabismus may be corrected the goal of treatment is to help the patient achieve as close to normal binocular vision as possible in every direction of gaze and at all distances
Nursing Intervention
Provide postoperative care to the patient. If the patient is a child requiring surgery, gently wipe the tears, which will be serosanguineous, using standard precautions, because the child may experience temporary diplopia after surgery. Reassure parents that this condition is normal. Administer antibiotic ointment or drops to affected area. Ensure safety
Health Teaching: Because the surgery is usually 1 day procedure, most patient are discharged after they recover from anesthesia. Postoperatively discourage the patient specially children from rubbing their hands. Encourage compliance with recommended follow up care. Teach the significant others/ patents how to administer eye medications and apply patches, if ordered. Teach the patient or parents eye exercises.
Nursing Diagnosis
Risk for infection related to Looking for a better standard of health. Readiness for enhanced hope Readiness for enhanced organized infant Readiness for enhanced self care. Readiness for enhanced comfort

Strabismus

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STRABISMUS

What is squint (strabismus)?

Exotropiaoutward turning of the eye

Cover test detects

Prism cover test measures total deviation

heterophoria Alternate cover test detects total deviation

Visual acuity tests in verbal children

Kay single picture

At age 3 years (matching tests)

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