Around 5 to 7% of all children in Central Europe have strabismus that requires treatment.
This is usually already recognisable in babies. This is because silver vision can be easily distinguished from the initial difficulty babies have in focussing their gaze.
"Oh how cute - our Timmy has a real little silver eye!" Tim's grandparents are completely enchanted by their four-month-old grandson. A "little silver eye"? Sounds kind of nice and maybe even looks cute on such a dwarf. In reality, however, a baby's squint should by no means be trivialised in this way. Because it's not just a small blemish, the standard recommendation is: seek paediatric advice immediately if you have even the slightest suspicion that your child might be cross-eyed!
A light Strabismus (technical term for squinting) is affectionately referred to as "little silver eyes", as in Timmy's case. But this is exactly what needs to be checked by a doctor so that it doesn't become a permanent problem!
The treatment options for strabismus and their chances of success are extremely good in order to avoid permanent visual impairments. In over 90% of cases, strabismus is cured and, among other things, permanent farsightedness is avoided. Here too, the earlier the better. That is why Preventive medical check-ups In your paediatric practice, checking your child's eyes is always on the agenda. If necessary, young patients are then referred to the ophthalmological practice.
Why do babies squint?
As already mentioned, it is not unusual for very young babies to squint at first. After all, they still have to literally Learning to see. This means that the connection between the eyes and the brain, where the incoming sensory stimuli are processed into images, is constantly being "expanded". However, the eye muscles are already fully developed and allow the baby to move its eyes in all directions.
When a baby is cross-eyed, the muscle coordination of both eyes focussing on the same object is impaired because the brain sends incorrect signals to the eyes. So when the child looks at an object, it is only looked at by one eye, while the other eye "wanders off" (usually inwards, but also outwards). This can happen constantly or every now and then.
In this way, however, the brain cannot compose a uniform three-dimensional image from the stimuli it receives. This results in two images: one provided by the fixating eye and another generated by the "wandering" eye. Because such double images confuse the brain in the long term, it begins to suppress the images that arise from the impulses supplied by the squinting eye. To put it bluntly: the brain ignores the wandering eye and simply excludes it from the visual process. However, this eye no longer has anything to do with it and gradually forgets how to see. In technical terms, this eye becomes "weak-sighted". In this case, glasses no longer help. The child is left with only one "properly" functioning eye. This means that three-dimensional vision, which is important in many situations and professions later on, is no longer possible. For three-dimensional vision, the brain needs two identical images that it can superimpose on top of each other.
What are the causes of strabismus?
As already mentioned, very young babies can sometimes squint for no reason. However, there are also various possible causes for this malfunction, which often cannot be clearly identified. The child is often farsighted. In this case, the brain gives the eye muscles the command to bend the lens more in order to see clearly. However, this causes both eyes to turn inwards.
A viral infection or developmental disorders may also be the trigger for strabismus. For example, babies in particular should be examined after a Premature birth be examined for strabismus or defective vision. Conversely, your paediatrician will pay particular attention to any developmental delays in children with strabismus.
In rare cases, a congenital cataract, i.e. a clouding of the lens, or a tumour can also be the cause of strabismus.
Strabismus can also be inherited. If two parents have strabismus, there is a 50 per cent chance that their baby will also have strabismus.
When to seek paediatric advice with a cross-eyed baby?
If your baby is younger than six months and only occasionally squints after waking up, for example, this is no cause for concern. As I said, this often happens for no reason. The situation is different if a child is constantly cross-eyed in the first six months of its life, if it is a premature baby, if it has a developmental disorder or if at least one parent is cross-eyed or has been cross-eyed. In this case, a baby should be seen by an ophthalmologist as early as three months of age. There, an orthoptist regularly looks after the squinting little ones. These are professionals who, in collaboration with the doctor, specialise in the examination and treatment of strabismus, among other things.
If the baby is older than six months, paediatric advice should be sought at any time, even if only a slight squint is suspected. To emphasise once again: The earlier strabismus in babies and toddlers is treated, the greater the chances of recovery. And, as already mentioned, these are very good. This allows you to set an important course for your child's future life.
How is strabismus treated in children?
As babies and very young children cannot or can barely articulate what and how they see something, certain orthoptic tests can provide information about this. Depending on the age of the child, some things can be diagnosed in a playful way.
You have probably already seen babies or children with one eye taped. Then the child is in the pain-free so-called Occlusion treatment. The aim is to strengthen the weaker eye, i.e. the squinting eye. To achieve this, the normally functioning eye is covered for hours or even days at a time. This forces the weaker eye to temporarily take over all vision. The aim is to bring both eyes "up to speed" together. The (daily) duration of the masking depends on how old the child is and how severely they squint.
Occlusion therapy is sometimes combined with wearing glasses. Depending on how severe the squint is, the visual aid reduces or corrects the squint angle. Glasses can also compensate for any existing long-sightedness.
If the squint is very pronounced, i.e. if there is a large squint angle, or if the malfunction causes discomfort, an operation may be necessary. In Germany, this is often performed one year before the child starts school, but never before the age of two.
