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Strabismus or eye deviation


Strabismus is a visual problem in which the eyes are not aligned properly and point in different directions. The condition may be present occasionally or constantly, in one eye or, more commonly, in both eyes.


How often does it appear?

– 4-5% of new-borns in one year have strabismus

– 50% develops amblyopia (lazy eye)


What are the causes?

– Heredity – especially a family history of refractive errors (myopia, hypermetropia, astigmatism) – in 60-80% of cases;

– Nervous system disorders: neonatal neurological history – prematurity, dysmaturity, cerebral motor disability, meningitis;

– Trauma of the skull, orbits;

– Refraction errors, differences in refraction between the two eyes;

Hypermetropia is commonly associated with convergent strabismus;

– Congenital changes in orbital bones;

– Unilateral ptosis (fallen eyelid);

Unilateral congenital cataract;

The vast majority of children with strabismus, however, have none of these problems.

Some tend to think that the baby has a period of physiological instability in which it is “normal” for the eyes to exhibit some instability. Deviations (strabismus) can be considered “normal” if they are intermittent, usually divergent (i.e. outward) and disappear after 6 months of age, with a stable and parallel position of the eyes. Those which are constant, ample, visible and not disappearing after this age hide big imbalances and, as a rule, the treatment should be started early.

There is a so-called “strabismus from birth”, that is, the one noticed from the first days of life and which continue to be present after the age of 6 months. Specialists call this “infantile or congenital strabismus” and the recommendation is that the child should be examined as soon as possible by a paediatric ophthalmologist. Examination of a child less than one year of age requires a child specialist and not a general ophthalmologist because the protocol, means of examination and experience are completely different. One should not forget that the appearance of a “running” eye can hide serious medical conditions: congenital cataract, malformations, nerves and retinal disorders, sometimes tumours.

When should a baby be examined by an eye specialist?

  1. If it is born prematurely or suffered at birth (low APGAR score) – from the first days, as soon as its examination is possible. In large cities, there is a program for examination and treatment of premature babies in hospital just after birth. There are specialists in Romania who deal with this successfully.
  2. If it was born in term, with normal weight, but with obvious deficiencies at eye level – marked asymmetry, white pupil, nystagmus, different size of cornea or eye ball, deviation of both eyes inward or outward, lack of reaction to visual images or visual stimuli . Such a child should be examined under the age of 6 weeks.
  3. If within first 6 months the child has intermittent or permanent strabismus of one eye and this persists after the age of 6 months, it is advisable for the child to be examined by the paediatric ophthalmologist.
  4. If the child has no disorders for up to 6 months, but then a permanent or intermittent strabismus is installed, the child should be examined by the paediatric ophthalmologist.

Diagnosing and initiating an early treatment of strabismus should be the goal of parents and ophthalmologists, because the most important period for developing of a normal vision of both eyes and binocular vision (space vision) is the period of up to 2 years.

Any imbalance unsettled during this period may lead to lack of development, impossible to solve later, even if the position of the eyes can be corrected. Strabismus can cause a delay in the child’s mental development.

This is why strabismus that occurs after two years of age is somewhat easier to treat and is associated with better functional results.

Chances of success are greater if the treatment starts early.

Treatment of infantile strabismus

Sometimes such treatments as the prescription of special glasses or contact lenses, eye exercises, etc., may be enough to treat strabismus. Other treatments may involve surgery to correct the unbalanced eye muscles or to remove a cataract. Surgery for strabismus provides a good cosmetic effect as it works to straighten the eyes, but it does not restore binocular (two-eyed) vision.

Therefore, patients need a postoperative recovery therapeutic course (offered at the Optisan Clinic) to help them adjust to the new eye conditions and gets the best results.


The therapeutic treatment of strabismus

Strabismus is a visual problem in which the eyes are not aligned properly and point in different directions. In strabismus, doctors strongly recommend starting treatment as soon as possible to prevent the development of complications and to enable early functional rehabilitation.

Generally, the treatment of strabismus is a complex one. The treatment choice depends on many factors: the age of the patient, the causes of strabismus and the direction of deviation.

Treatment methods include: wearing eyeglasses, therapeutic treatment and surgery (if necessary).

In some cases optical correction and therapeutic treatments may be enough to normalize the visual function. For accommodative esotropia, glasses reduce the focusing effort and often straighten the eyes. Sometimes bifocals are needed for close work.

These are also necessary to eliminate amblyopia (which often accompanies strabismus) and to restore the connection between the two eyes. The patient’s brain is trained to combine the two pictures into a single, three-dimensional image. This three-dimensional image gives us depth perception.  If necessary, the lenses can have a prismatic effect, which makes it possible to approach the images obtained by each eye.

At Optisan Clinic, ophthalmologists deal with this problem quickly and effectively by complex vision stimulation with special equipment. The cure of therapeutic treatment makes it possible to significantly improve vision. For more details, contact us at



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