Ophthalmology Clinic
Treatment for Strabismus

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A whole new look
Surgery benefits children, adults with a 'lazy eye'

Strabismus -- an eye disorder affecting the muscles that causes crossed eyes and other conditions -- is commonly thought of as a childhood disorder.

But experts say the same percentage of adults as children, 4 percent, have the disorder, which can cause poor self-esteem, problems establishing relationships and even affect the ability to get a job.

"The most common treatment by far is surgery, and an average of 80 percent of children and up to 90 percent of adults will have the problem fixed with one surgery," says Dr. David Coats, chief of the department of ophthalmology at Texas Children's Hospital.

"We actually do an adjustable surgery for adults just using eye drops to numb the eye and having the patient participate (by staring at a dot on the ceiling and telling the doctor when they can see best) in getting the placement right."

Strabismus, the misalignment of the eyes, occurs when one or more of six eye muscles don't function properly. It includes conditions commonly known as crossed eyes, lazy eyes (amblyopia), wandering eyes or floating eyes. Causes can include a weak eye muscle, a damaged nerve or a problem in the part of the brain that controls the muscle.

Children generally develop strabismus in the first few years of life for reasons doctors still don't understand.

"It's a fallacy to think that a child is born with it," said Coats, assistant professor of ophthalmology and pediatrics at Baylor College of Medicine. "There is some defect in the brain's ability to control and move the eye. The ability to see is a complex process, and in a system that complex, something is going to go wrong sometimes."

In adults, strabismus can occur after a traumatic injury or stroke, he said. And some adults just never got treatment as a child.

Because pediatricians most commonly treat strabismus, they typically treat adults as well, said Coats, whose waiting room includes infants to adults up to age 80 or 90.

"Some people feel funny coming to a pediatric eye hospital, but that's where they need to come," Coats said. "We just have more experience with it."

After a severe head injury at age 4, Michael Pozebanchuk of The Woodlands spent most of his life having to turn his head to see people correctly. Like many adults who suffer from strabismus, trying to look straight caused him to see double.

"Children who develop strabismus usually don't see double because the brain is still developing and can correct for the problem. With adult-onset strabismus, most adults do see double," Coats said.

Pozebanchuk, who was in a coma for 10 days after a 1,200-pound fuel oil tank fell on him, had surgery on the left eye, which turned inward, soon after the accident. While the problem was alleviated somewhat, the strabismus steadily worsened until two years ago, at age 40, Pozebanchuk decided to see if it could be improved.

"I've been suffering in silence for decades over this. Physical appearance, and especially eye contact, is so important," said Pozebanchuk, whose complex case required Coats to perform four surgeries on the muscles of his eyes, including the most recent on Nov. 30.

Recent studies, including two done at Baylor College of Medicine and Texas Children's, have shown that people who have left strabismus untreated often face discrimination.

According to the results of one study led by Coats and published in the February 2000 issue of Ophthalmology, women with strabismus received lower hiring preference scores than women with normal alignment.

"Adults experience social and vocational problems," Coats said. "Patients tell us they have trouble with relationships, jobs, with looking someone in the eye."

Another Baylor and Texas Children's study, published in the November/December 2001 issue of the Journal of the American Association for Pediatric Ophthalmology, found discrimination against people with strabismus can begin in a child as young as 6.

In the study, children from ages 4 to 7 were given three dolls with which to play, including one with normal eye alignment, one with an eye aligned to the inside and the other with the eye aligned to the outside.

"Up to age 3 1/2, children did not notice any difference among the dolls," Coats said. "From 3 1/2 to 5 1/2, children noticed a difference but had no opinion. But around age 6, children became aware of the difference and that it was abnormal. They treated the strabismus dolls more roughly, yelled at them and used them as the `villain' doll during play. One child even slapped the doll (with strabismus) against the table and broke its torso."

Doctors at Baylor and Texas Children's are now beginning a study to see why adults with strabismus don't seek help to correct it.

"We think, in some cases, it hasn't bothered them until now. Some believe the myth that it can't be fixed after childhood, and some are afraid of another myth -- that they'll develop double vision," Coats said. "We're trying to understand it."

Pozebanchuk, meanwhile, is already experiencing a difference in his life in a variety of ways.

"I have virtually no head turn now -- just a little if I'm trying to see something far away," Pozebanchuk said. "The eye turn really affected how I felt about myself. I was very self-conscious. I wanted to do something because it was affecting my social life. Some of those (social and self-image) problems have been partially relieved because of getting it corrected."

This article originally appeared on Jan. 8, 2002, in the Houston Chronicle.

By Deborah Mann Lake, Special to the Chronicle