By John Frederick, MD, Eye Surgeons Associates
Children
aren’t the only patients we see with strabismus (eye misalignment).
Most people with eye muscle disorders are diagnosed before 5 years of
age. A large number of patients, however, are seen with this problem for
the first time as adults.
Young people with strabismus usually have a
benign disorder, rarely associated with serious disease. This is in
contrast to adult patients who are much more likely to have an
accompanying illness.
Adults with acquired strabismus may also suffer
from high blood pressure, diabetes, thyroid disease, stroke, aneurysm,
or brain tumors. Myasthenia gravis, Parkinson’s, temporal arteritis, and
multiple sclerosis may involve the eye muscles. Another more common
cause of adult-onset strabismus is head trauma (such as a concussion
during a motor vehicle accident, for example). This list mentions only a
small number of the possibilities to consider when dealing with ocular
motility disorders.
In children, the importance of early treatment
for strabismus is to prevent visual loss and preserve binocularity
(depth perception). With adults, prompt examination and referral to an
ophthalmologist or neurologist is necessary to diagnose the underlying
cause for the eye muscle disorder. It is important to remember that many
adults with strabismus may not have a serious medical disorder. This is
especially true for those patients who have had an injury as the cause
of their ocular motility problem and for adults who have actually had
their strabismus since childhood. A common misconception is that if you
did not have treatment for an eye muscle disorder in childhood that
nothing can be done for you as an adult. We see adults with strabismus
nearly every day in our practice and have a number of treatments to
offer them. Some of these patients will require surgery to restore them
to the best possible ocular alignment. These operations have similar
success rates in adults and children.
An important difference in the
presenting history of adults with recent-onset strabismus when compared
with children is the symptom of diplopia (double vision). Children very
rarely complain of double vision. This is in contrast to adult patients
who often seek out the care of a physician because of diplopia. Other
important symptoms to ask about in adults with a new eye muscle problem
include: headache, loss of vision, eyelid, or facial drooping, slurred
speech, and extremity weakness (stroke-like symptoms). Also ask about
fever, weight loss, scalp tenderness, jaw pain when chewing, worsening
joint pains, and fatigue (temporal arteritis symptoms), and any changes
in symptoms with certain activities, temperature, or time of day.
Another
frequent cause of strabismus in adults is poor vision in one eye. This
may cause the affected eye to drift outward over time. This combination
of problems may discourage some patients from seeking care, thinking
that nothing can be done for such an “old” problem. In some cases the
visual impairment may be due to a number of potentially correctable
causes, such as trauma, cataract, or corneal opacity (cloudiness). If
vision can be restored in these eyes by one or more procedures,
occasionally the ocular alignment will improve as well. Other patients
will require additional treatment for strabismus after their visual
rehabilitation has been completed.
Adults with strabismus present a
unique set of challenges to the eye care provider. These patients are
often best served by a team approach including an ophthalmologist who
specializes in pediatric eye disease and adult strabismus and a
certified orthoptist (specialist in eye muscle disorders). This team
will then consult with primary care physicians and other specialists
depending on the cause of the eye misalignment.
Dr. Frederick,
with Eye Surgeons Associates, is board-certified with a fellowship in
Pediatric Ophthalmology. He is a member of the American Association for
Pediatric Ophthalmology and Strabismus. Dr. Frederick practices at our
offices in Bettendorf, Iowa and Rock Island, Illinois. For more
information, please see our website: www.esaeyecare.com.