John C Hagan III, MD, FACS, FAAO  
Kansas City, MO

Specialties: Ophthalmology

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Information about Eye Muscle Disorders (Strabismus)

Dec 11, 2009 - 4 comments

Strabismus Treatment

Hello, Eye alignment disorders/diseases are called "strabismus" by Ophthalmologists. If the misalignment is the same in all directions it is called a "commitant" deviation; if the misalignment varies in different directions, or (as in your case) is present in only certain directions it is an "incommitant" deviation. Misalignment problems are either vertically or horizontally (as in your case) misaligned or both. If the eye are deviated towards one another ('cross eyed) it's an esotropia or convergent strabismus; if the eyes deviate away from one another it's a divergent or exotrophia ('wall-eyed'). Thus you have an incommitant deviation, probably a esotrophia. (I would have to examine you to be certain).

Commitant deviations are usually due to problems with the control centers ("fusion centers") in the brain and are usually present at birth or develop in childhood. Incommitant deviations are usually due to weaknesses of one or more of the 6 extra-ocular muscles that move each eye (12 all totaled). While they can be present at birth they are more likely to develop in adults and may be caused by trauma, diseases, injuries, etc. Because the nerves that elevate the eyelids and that make the pupil larger and smaller are located near the control centers for the extra-ocular muscles incommitant strabismus may be associated with a droopy eyelid, and pupils that don't work right.

Of the 6 extraocular muscles that move each eye four move the eye up and down (superior rectus, inferior rectus, superior oblique and inferior oblique) and two move the eye horizontally (medial rectus, lateral rectus).

When you look to the right you're using your right lateral rectus and the left medial rectus. Your description of your problem would implicate one of these two muscles as the cause of your problem. It would also be important to know if when you look right or left whether your upper and lower lids in either eye move up or down. A not infrequent cause of a problem like yours is called "Duane's Syndrome", a second would be a left lateral rectus palsy.

Prisms glasses do not work well on incommitant strabismus. You need to see a Pediatric Ophthalmologist. They are the strabismus experts of the profession of Ophthalmology. They have extra training in eye muscle problems; although most of their patients are kids almost all of them do adult strabismus.

Because you used your eye care insurance and were given prisms, I suspect you saw an optometrist. A Pediatric Ophthalmologist is a physician (MD) that has been to medical school and taken an extended Residency (EyeMD). Because you have a medical problem your evaluation should be covered under your HEALTH insurance. You can check with your insurance carrier to confirm this or you can call the Pediatric Ophthalmoloist you're going to see and confirm that they participate in your plan. Almost all major cities have Pediatric Ophthalmologists and they can also be found in the Department of Ophthalmology of all medical schools and on the faculty of most Children's Hospitals.

Many of the important diagnostic findings in strabismus are very subtle and even you may not have noticed things that are important to the Pediatric Ophthalmologist in making a diagnosis and giving you your medical and surgical options.

Good Luck

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Avatar universal
by MSmith939, Jan 15, 2010
I have a question about alternating intermittent exotropia. I had surgery for it as a child, but it has gradually returned in my 20s.

I've seen information about squinting or closing one eye in bright light as one of its symptoms. Can this squinting get "burned in" like a writer's cramp or some kind of dystonia?

In my case, it feels like the eyelid muscles got overdeveloped over time in my right eye (the one that squints in bright light) to the point where I can consciously and visibly "clench" them in isolation from the left eye. I can't really unclench them though. Wearing 12 diopter prism glasses for the past year [prescribed by a neuro-ophthalmologist surgeon] seemed to accelerate this process.

My question is: does it make sense that exotropia could cause an eyelid problem? Or is it more likely a coincidence of having two separate conditions? Thanks in advance for your insight.

Avatar universal
by casey59, Mar 06, 2010
I am 66 and have macular pucker in my left eye, after an eye exam by my optometrist, she said I have strabismus in that eye also, I have been noticing eye strain for some time, but attributed it to the pucker, my question is could the loss of vision in my eye with the pucker cause the strabismus? Thank you

Avatar universal
by Buddhapest, Feb 02, 2016
Hi.  I am a 36 yr old relatively healthy female that has been addicted to opioids for over a year now. It started with pain pills after surgery, then after doc cut me off....I reluctantly resorted to buying heroin off st.  A little over a month ago I had had enough of the darkness and just quit cold turkey. Well since about day three my left eye is crossed all of a sudden. Each eye works fine on its own, however, together, it is a hot mess.  I have always had good vision and most definitely, NOT a crossed eye. I am waiting for my Oregon Health Plan to go through so I will have insurance.  It could take two more weeks and I can't stand the embarrassment;  not to mention, I can't see unless I cover one eye.  
       Desperately seeking educated advise.  Thank you very much.  

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by JohnHaganMD, Feb 02, 2016
Get your appointment lined up with OHP ASAP both for an eye exam, ideally by a Eye MD and a general physical. This can sometimes be due to being 36 and farsighted. Try a +1.00 magnifier reading glasses at a drug store and see if it helps. If so you can wear them until you have your exam. If it doesn't help or blurs the vision not much you can do till exam. JCH MD

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