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Strabismus Surgery in Pediatric Patients

Jennifer almost panicked when she heard that her 12-month-old daughter, Alyza, needed reconstructive surgery in her right eye to correct strabismus, a misalignment of the eyes, but she had done her homework and had complete trust in Leonard B. Nelson, M.D., a nationally recognized expert in strabismus at Ophthalmic Partners of Pennsylvania. Acknowledging that surgery was important for her daughter’s overall vision, Jennifer scheduled the surgery for the following month.

It is estimated that 4 percent of the population has strabismus. It occurs when an eye turns up, down, in, or out, causing both eyes to look at different points. Strabismus is often inherited and usually develops in infants and young children, often by age 3, but older children and adults can also develop the condition. Any child older than four months whose eyes do not appear to be straight all the time should be examined, as it is important to treat strabismus to avoid vision problems.

“Strabismus is a disorder of the binocular system of the brain—not a dysfunction of the eye muscle,” states Dr. Nelson. “It is critical to get the two eyes lined up so that they work together.”

The brain receives two different images as a result of the misalignment. This may cause double vision at first, but over time the brain learns to ignore the image from the turned eye. If the turned eye is not treated, it can lead to a permanent reduction of vision, a condition called amblyopia or lazy eye.

Strabismus is usually obvious to the family and the pediatrician of the affected child. Children with vertical strabismus may also tilt their head to align their eyes, which can be first mistaken for an orthopedic problem. At Alyza’s 9-month doctor’s visit, her pediatrician noticed that one eye was crossing and both eyes were “dancing.” After an unsatisfied visit to their local pediatric ophthalmologist, Jennifer and Alyza made the two-hour trip to Dr. Nelson’s office.

The first line of treatment for strabismus may be glasses and/or eye exercises. In Alyza’s case, she wore glasses for a month before Dr. Nelson determined she needed surgery in the right eye. Her left eye was already showing improvement.

Jennifer had portraits taken of Alyza on her first birthday and again in the spring, after the surgery. “The difference is a completely different child! We are brought to tears with how happy we are for saving Alyza from having impaired vision,” shares Jennifer.

Alyza is now five and half years old. She sees Dr. Nelson every six months, and she still wears glasses, for now. Her vision continues to improve, and it is possible that in the future she will not need glasses. Her eyes are no longer “dancing.”

Keeping eyes healthy from an early age is the best way to prevent the development of eye disease and to ensure that vision problems do not interfere with normal physical development and education. A number of pediatric ophthalmology conditions are treated by expert physicians at Ophthalmic Partners of Pennsylvania, the region’s largest multi-subspecialty ophthalmology practice.