Diabetes, High Blood Pressure, and Inflammation of the Eye Muscles May Cause Squint (Strabismus) in Adults: An Interview with Dr Walid Abdalla - Sehatuna Magazine on February 2012

Dr Walid Abdalla, consultants ophthalmologist and head of pediatric ophthalmology, strabismus & oculoplasty unit (Plastic Eye Surgery) at the Eye Consultants Clinic in Dubai and fellow at the Royal College of physicians and surgeons of Glasgow says : viral inflammation of the optic nerves, high blood pressure, and diabetes can directly lead to paralytic (or paretic) strabismus in seniors and adults, pointing out that treating these cases may take 3-4 months, he also added that swelling of the extraocular muscles is the main cause for non paretic strabismus where he recommends treating lazy eye conditions (amblyopia) first before treating strabismus.

Dr Walid Abdalla categorizes strabismus conditions in adults into two types, paretic strabismus and non paretic strabismus, were the first kind is caused from a problem in one of the nerves feeding the eye muscles that is caused by diseases or viral inflammation of the eye’s nerves, or in many cases, due to due to high blood pressure. It can also be caused by high blood sugar levels in those with diabetes. With the right treatment, these cases can be resolved within 3-4 months. Whereas non paretic strabismus causes misalignment in vision which requires the use of special prescription eyeglasses.

Squint conditions that lead to inflammation of the eye muscles as in the cases of over activity of the thyroid glands or cramping in the eye muscles, will most likely need surgical intervention to fix the eye position after a period of eye medications.

Types of Squint:

Dr Walid Abdalla categorizes squint into two general categories: the first affects children and the second affects adults and seniors, indicating that the first type is further categorized into squint that occurs in children at birth or within the first six months after birth,where, this type needs surgical intervention to correct the child’s vision problems.

The other type of squint in children usually occurs after 2 years of age, and is most likely a result of farsightedness (hyperopia) in the child’s vision. It can also be caused by a head injury or a high fever that causes squint to appear suddenly. Treatment of most these cases is done by prescribing special medical eye glasses and through regular follow up visits at a specialized eye clinic to assess the condition of the squint and to treat any degree of lazy eye that could be present.

He also stressed the importance of distinguishing between pseudostrabismus (or false appearance of strabismus) and true strabismus in children during diagnosis, where he classified that the first kind ,pseudostrabismus, is not a medical condition, and does not need treatment and often disappears on its own naturally at 7 or 8 years of age. He also pointed out that the eye specialist should determine whether squint is the only symptom exhibited by the patient or whether there are other accompanying symptoms due to other eye diseases, such as cataract, diseases in the retina, or the optic nerve, where any of these diseases can inflict a child’s eyes at a young age, and not diagnosing these conditions early on can cause secondary strabismus in one of the child’s eyes.

Monitoring Eye Movement:

Dr Walid Abdalla advises parents to monitor their children when playing, reading, and while watching TV, because eye movement in different directions usually uncovers squint, as the child usually sways his/her head in a certain direction in order to align the affected eye in the opposite direction in order to see images in a congruent fashion. If this condition is neglected, the risk in the long term is that it could lead to weakening of the the neck muscles and treatment could be much more complicated.

He also called for treating lazy eye before starting treating squint, clarifying that lazy eye conditions means a weakness in vision, which is result of the brain neglecting the information coming from the lazy eye and concentrating on the information coming from the healthy eye. An eye specialist is able to determine the degree of eye laziness and the to what extent is the vision weakness using specialized equipment.

He also clarified that treating lazy eye is only possible in children until 8 years of age only. In the case of adults, vision weakness that is caused by lazy eye becomes a permanent condition. And from this aspect, he stressed the importance of diagnosing and treating squint and lazy eye at a young age.

In the case of squint, treatment is done by prescribing medical eye glasses to fix any problems in vision refraction if present, or by performing a simple surgical procedure that lasts 20 - 30 min under general anesthesia. The child is then transferred to a private room to wake up after 3-4 hours and is be able to go home on the same day.

Dr. Walid M. Abdalla MD, FRCS

Ophthalmology Consultant

Head of Pediatric Ophthalmology, Strabismus & Oculoplasty Unit (Plastic Eye Surgery)

Fellow at the Royal College of Physicians and Surgeons of Glasgow