What are the common types of Strabismus and their management options?

The two most common types of strabismus are esotropia, where an eye turns in and exotropia, where an eye turns out. Infants developing esotropia within the first six months of life (Congenital or Infantile Esotropia) usually have a large inward turn, which is easily noticed. The chances of developing normal binocular vision with normal depth perception are not good and the child may not develop full vision in the weaker eye. However, the best chance is with early surgery (before 18 months of age). Both the parent and surgeon have to be committed to multiple procedures to obtain perfect alignment. Another common form of esotropia that occurs in children usually after age two is caused by a need for glasses (accommodative esotropia). These children are farsighted (hypermetropia or plus power in spectacles). They have the ability to focus their eyes enough to adjust for the farsightedness, which allows them to see well for both distance and near. Some children excessively strain their eyes when they focus, which causes one eye to turn in. Wearing glasses equal in strength to their farsightedness reduces the need to focus and straightens their eyes. Sometimes the addition of bifocals is necessary to further reduce the need to focus when looking at objects up close.

Exotropia or an outward turning of an eye is another common type of strabismus. Often the exotropia will occur intermittently, particularly when the child is daydreaming, ill, or tired or focusing at distant objects. Although glasses and prism therapy may reduce the amount of outward turning in some patients, surgery is usually needed. Rarely, special eye exercises (orthoptics) are necessary to help older children control the eye misalignment.