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Strabismus refers to the misalignment of the eyes. They may be turned in (esotropia), turned out (exotropia), turned up (hypertropia), or turned down (hypotropia). Strabismus can be constant, or intermittent and can occur in childhood or later on in adulthood from various reasons.
In children, there are several main types of strabismus. Children who were born with eyes turned in have congenital esotropia and are closely linked to amblyopia, or reduced vision in the misaligned eye. These usually require early surgery. Sometimes children have a high farsighted prescription that causes their eyes to turn inwards and is called accommodative esotropia. These can be treated with glasses or even bifocals. Another common type is exotropia when the eyes turn outward especially when focusing on distant objects. This may occur intermittently especially when the child is tired, daydreaming or ill. These may need surgery as well.
The management of amblyopia in a child is also very important. This refers to when the brain ignores the image of the misaligned eye so as not to create double vision. This in turn prevents the misaligned eye to develop good vision. Patching, whether it is mechanical or medicinal, is important in strengthening the vision in the weaker eye. This can be successful if treated early.
In adults, the causes for newly acquired strabismus can be from diabetes, thyroid disease, stroke, brain tumor, orbital fractures, or other neurological disorders. So adults need to be carefully evaluated for medical or neurological causes. However, most cases seem to be due to history of childhood strabismus. These are treated according to the cause and vary depending on them.
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