Dear Readers,
Strabismus and amblyopia are common conditions in childhood, with strabismus affecting about 5% of five year olds of whom 60% have eso-deviations and 20% exo-deviations. Amblyopia has an estimated prevalence in childhood of 1.2% to 4.4% depending on the defining criteria.Strabismus or amblyopia may lead to failure to develop binocular vision which may prevent an individual pursuing certain occupations. The associated cosmetic disorder may interfere with social and psychological development with potentially serious effects for patients young and old.

Severe amblyopia persisting in adulthood is a significant risk factor for blindness in the case of an individual losing sight in the fellow eye. Timely diagnosis and appropriate treatment of children with strabismus and/or amblyopia is likely to reduce the prevalence of persistent amblyopia and ocular misalignment in adults. Rarely, strabismus and/or amblyopia may be the presenting symptom in children with a serious eye disease or systemic condition (e.g. retinoblastoma or hydrocephalus) when urgent referral to a specialist may be necessary.

This issue Introduces you to the Strabismus, talks about magnitude of strabismus, enables you in understanding its problems. It also discusses about various surgical interventions.

The organization we are featuring is International Strabismological Association and the featured personality is Dr. ARTHUR JAMPOLSKY. You will know more about the history of Strabismus. we wish you an experience of learning that is very practical. Your feedback will let us know how we can improve. Please send in your feedback at eyesite@aravind.org. We wish you happy reading and do look forward to receiving your feedback.


Vision 2020 e-resource team
The Issue Features...
Vol. 6 No.5 May 2010
•   Introduction
•   Magnitude
•   Understand the Problem
•   Barriers
•   Surgical Interventions
•   History of Ophthalmology
•   Featured Personality
•   Featured Organisation
•   Talk to Us
•   Past Issues


Strabismus is a common condition among children, but can also occur later in life. It occurs equally in males and females and may run in families. However, many people with strabismus have no relatives with the problem.

The exact cause of the misalignment is not fully understood. Six eye muscles, controlling eye movements, are attached to the outside of each eye. In each eye, two muscles move the eye right and left. The other four muscles move it up or down and control tilting movements. To line up and focus both eyes on a single target, all eye muscles of each eye must be balanced and working together with the corresponding muscles of the opposite eye.


Strabismus is misalignment of the eyes, which produces deviation from the parallelism of normal gaze. Diagnosis is clinical, including observation of the corneal light reflex and use of a cover test. Treatment may include correction of visual impairment with patching and corrective lenses, alignment by corrective lenses, and surgical repair.

Strabismus occurs in about 3% of children. Although most strabismus is caused by refractive errors or muscle imbalance, rare causes include retinoblastoma or other serious ocular defects and neurologic disease. Left untreated, about 50% of children with strabismus have some visual loss due to amblyopia.


Prevention of vision loss associated with strabismus is critical. Early vision screening starting at 6 months of age is becoming increasingly common among pediatricians. Vision screening in children is also becoming easier with the development of vision screening tests which measure brain waves in response to objects. These newer techniques allow vision screening in very young children in a pediatric office which is painless and quick. Again, the major consequence of strabismus in young children is permanent vision loss, so children should undergo vision screening and at the first indication of eye misalignment call your pediatrician.


Treatment aims to equalize vision and then align the eyes. Children with amblyopia require patching or penalization of the normal eye; improved vision offers a better prognosis for development of binocular vision and for stability if surgery is done. Patching is not, however, a treatment for strabismus. Eyeglasses or contact lenses are sometimes used if the amount of refractive error is significant enough to interfere with fusion, especially in children with accommodative esotropia. Topical miotic agents, such as echothiophate iodide 0.125%, may facilitate accommodation in children with accommodative esotropia. Orthoptic eye exercises can help correct intermittent exotropia with convergence insufficiency.

Surgical repair is generally done when nonsurgical methods are unsuccessful in aligning the eyes satisfactorily. Surgical repair consists of loosening (recession) and tightening (resection) procedures, most often involving the rectus muscles. Surgical repair is typically done in an outpatient setting. Rates for successful realignment can exceed 80%. The most common complications are overcorrection or undercorrection and recurrence of the strabismus later in life. Rare complications include infection, excessive bleeding, and vision loss.


During eye examinations, orthoptists, ophthalmologists and optometrists typically use a cover test to aid in the diagnosis of strabismus. If the eye being tested is the strabismic eye, then it will fixate on the object after the "straight" eye is covered, as long as the vision in this eye is good enough. If the "straight" eye is being tested, there will be no change in fixation, as it is already fixated. Depending on the direction that the strabismic eye deviates, the direction of deviation may be assessed. Exotropic is outwards (away from the midline) and esotropic is inwards (towards the nose); these are types of horizontal strabismus. "Hypertropia" is upward, and "Hypotropia" is downward; these are types of vertical strabismus, which are less common.

A simple screening test for strabismus is the Hirschberg test. A flashlight is shone in the patient's eye. When the patient is looking at the light, a reflection can be seen on the front surface of the pupil. If the eyes are properly aligned with one another, then the reflection will be in the same spot of each eye. Therefore, if the reflection is not in the same place in each eye, then the eyes aren't properly aligned.


The practice of strabismus surgery began inauspiciously in 1739 with the efforts of John Taylor. He is reported to have had ...a considerable amount of sense..., according to Stewart Duke-Elder, who said Taylor undoubtedly recognized that strabismus was a muscle abnormality that could be treated by dividing the extraocular muscles. However, Taylors surgery was not successful. On the contrary, Taylor is said to have been a showman who may have only snipped the conjunctiva, patched one eye, and left town before the results could be assessed. By patching the unoperated eye and having the operated eye take up fixation, Taylors procedure would have given the appearance of being successful since the operated eye would appear to have been straightened. John Taylors position in history appears to be one of ridicule rather than honor.




Dr. Arthur Jampolsky, MD practices in San Francisco, CA. Ophthalmologists examine and treat common vision disorders eye injuries and eye diseases. Ophthalmologists such as Arthur Jampolsky, MD are licensed medical doctors and can prescribe medication perform eye surgery.

Dr. Arthur Jampolsky, was born in Bismark, North Dakota. After obtaining his degree in optometry, he pursued a degree in medicine. Following his postgraduate training, he established a private practice in association with his residency alma mater, Stanford University, now Pacific Medical Center, and soon became known as the strabismus authority. Residents from all Bay Area programs and from around the world eagerly sought the opportunity to observe Dr. Jampolsky's patients and surgery. Dr. Jampolsky trained hundreds of fellows in strabismus, and they can now be found on every continent.

As a co-founder of the American Association for Pediatric Ophthalmology and Strabismus, he was a major proponent for the addition of "strabismus" to the title and scope of the organization. He has also served as its President and has given its prestigious Costenbader Lecture. In addition, he became a strong presence in multiple capacities at the NEI, NIH, and ARVO. He has hosted major NEI-sponsored meetings on strabismus, vision development, and visual rehabilitation. Dr. Jampolsky has been an AOS member since 1970.



The International Strabismological Association (ISA) was formed in 1966. The ISA meets once every four years. The most recent meeting of the ISA was held February 18-20, 2006 in Sao Paulo, Brazil immediately prior to the World Congress of Ophthalmology meeting. This tenth meeting of the ISA was a joint meeting with the Latin American Council of Strabismus (CLADE).

The aims of the association are:
  • To disseminate knowledge on all sensory and motor aspects of strabismus and other disorders of ocular motility.
  • To foster clinical and experimental research
  • To encourage and support countries wishing to set up organizationsfor the study and treatment of strabismus and associated sensory disorders.
  • To create, as far as possible, a common terminology and a standardization of diagnostic and therapeutic procedures.
  • To relate closely to the International Council of Ophthalmology and officially represent the specialty of strabismus and disorders in ocular motility at the International Congress of Ophthalmology.


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