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Frequently Asked Questions (FAQs)

At-a-Glance

FAQs are composed and periodically reviewed by pediatric ophthalmologists and certified orthoptists from the Public Information Committee of AAPOS:

Why Does a Child Need Glasses?

Children may need glasses for several reasons—some of which are different than for adults. Because a child’s vision system is growing and developing, especially during the first 5-6 years of life, glasses may play an important role in insuring normal vision development.

How Can a Child Be Tested for Glasses in Early Childhood?

An ophthalmologist can detect the need for glasses through a complete eye exam. Typically, the pupils are dilated in order to relax the focusing muscles, so that an accurate measurement can be obtained. By using a special instrument, called a retinoscope, your eye doctor can arrive at an accurate prescription. The ophthalmologist will then advise parents whether there is a need for glasses, or whether the condition can be monitored.

What Should be Done if a Child has a Eye Injury?

If there is a chemical injury, immediate irrigation with water is critical. Flush the eyes and face with any available source of water for at least 10-15 minutes. Follow up immediately with a trip to the emergency room or ophthalmologist.

If a sharp object has penetrated the eye (like a fish hook), do not pull it out, but transport the person to the emergency room as soon as possible. Other blunt or sharp injuries should be examined by an ophthalmologist, since the serious nature of the injury may not be readily apparent.

Where do Most Eye Injuries Occur?

An eye injury can occur at any time, in any place. Adequate prevention is important and could probably eliminate most eye injuries. Close to 50% of injuries occur in sports and recreational activities--more often in children and teens than any other age group.

What Is Strabismus and How Common Is It?

What is strabismus and how common is it?
Strabismus is any misalignment of the eyes. It is estimated that 4% of the U.S. population has strabismus.

Are there different types of strabismus and if so, how are they named?
There are many different types of strabismus. Strabismus is most commonly described by the direction of the eye misalignment; common types of strabismus are esotropia, exotropia, hypotropia, and hypertropia.

Strabismus can also be described by its cause. The 3 cranial nerves (III, IV, VI) responsible for eye movement can be weak or palsied and cause strabismus. Some examples of paralytic strabismus include third nerve palsy and superior oblique palsy.

Special patterns of strabismus can have unique names such as Brown syndrome, and Duane syndrome.

What are the types of horizontal strabismus?
Esotropia is inward turning of the eyes (aka "crossed eyes"). Types of esotropia include infantile esotropia, accommodative esotropia, and sixth nerve palsy. Exotropia is the term used to describe outward turning of the eyes (aka "wall-eyed") [See figures 1 and 2].

Large-angle infantile-onset esotropiaWhat are the types of vertical strabismus?
The terms hypertropia and hypotropia are used to describe vertical misalignment. Hypertropia is an abnormal eye higher than the normal eye. Hypotropia is when the abnormal eye is lower than the normal eye. The terms can generally be interchanged.

What causes strabismus?
Most strabismus is the result of an abnormality of the poorly understood neuromuscular (including brain) control of eye movement. Less commonly, a problem with the actual eye muscle causes strabismus.

Child with exotropia of the right eye.How is strabismus related to poor vision?
Eye misalignment can cause amblyopia in children. When the eyes are oriented in different directions, the brain receives 2 different visual images. The brain may ignore the image from the misaligned eye to avoid double vision, resulting in poor vision development of that eye. Also, an eye that sees poorly tends to be misaligned.

Who develops strabismus as a child?
Strabismus often occurs in children who are otherwise completely normal. However, disorders that affect the brain such as cerebral palsy, Down syndrome, hydrocephalus and brain tumor are more likely to develop strabismus.

What adult disorders cause strabismus?
Stroke is the leading cause of strabismus in adults. Trauma, neurological problems, and Graves disease (thyroid eye disorders) are other common causes of strabismus.

How does trauma cause strabismus?
Trauma can cause strabismus by 1) brain damage that impairs control of eye movement, 2) damage of the nerves that control eye movement and/or 3) damage of the eye muscles either directly or secondarily from trauma to the eye socket.

How is strabismus treated?
The goal of strabismus treatment is to improve eye alignment which allows for better work together (binocular vision). Treatment may involve eye glasses, eye exercises, prism, and/ or eye muscle surgery. Problems associated with strabismus (including amblyopia, ptosis, and cataract) are usually treated prior to eye muscle surgery.

How is Strabismus Treated?

The goals of strabismus treatment are to improve eye alignment and mobility, thus allowing the eyes to work together better. Different kinds of strabismus require different treatments – these include glasses, exercises, prisms, eye muscle surgery, and eye muscle injection. Pediatric ophthalmologists have special training and interest in applying the best treatment for each individual patient.

What Causes Strabismus?

Most strabismus is the result of an abnormality of the poorly understood neuromuscular (including brain) control of eye movement. Less commonly, a problem with the actual eye muscle causes strabismus.

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