Strabismus should not be seen as a cosmetic issue

Irish College of Ophthalmologists, Annual Conference, Knockranny House Hotel, Westport, Co Mayo, 15-17 May 2024.

Strabismus can cause significant negative psychosocial impacts, not to mention potential visual complications, and should not be seen as a minor or ‘cosmetic’ issue, the Irish College of Ophthalmologists 2024 Annual Conference was told.

Strabismus is a common problem, present in approximately 4 per cent of the population, and can cause various functional visual problems including diplopia, impaired depth perception, and loss of binocular single vision. Speaking about the latest strabismus management approaches during the vision and strabismus symposium, Mr Ian Marsh, Consultant Ophthalmic Surgeon, Liverpool University Hospital NHS Trust, Liverpool, UK, said there has been much progress in the area over the last number of decades.

Mr Marsh, one of the UK’s leading long-established experts in strabismus, runs a comprehensive strabismus service mainly for adults but also including more complex children’s squints. As well as squint revision surgery, he performs squint surgery using adjustable sutures, and offers Botox for certain types of squint. Traditionally, strabismus surgery was primarily performed in children and there is a remaining perception among some people that the surgery is not performed in adults who are not experiencing visual problems.

However, it can be very beneficial in this cohort, Mr Marsh explained.

“Strabismus is the result of a disease process, which leads to a deviation from normality,” he said. “Strabismus surgery is performed to restore normality.”

In addition, the risk of strabismus increases with age, as eye muscles weaken, so it can re-emerge or develop for the first time in older adults, but they can be generally successfully treated, Mr Marsh said.

Recent developments in strabismus management have included the introduction of bupivacaine injections to permanently straighten eyes with small angle deviations, and the use of inferior medial rectus plication in near exotropia, he told the meeting.

In relation to adults, the quality-of-life impact, prejudice, and stigma surrounding strabismus is under-appreciated, Mr Marsh maintained.

He told the Medical Independent that a squint can significantly impact on confidence and relationships, as well as a person’s economic status, as proven by a number of published studies. “I’d really like to get rid of the word ‘cosmetic’ in relation to adult squint surgery and use something like non-functional or reconstructive surgery, because cosmetic means to beautify but what we are doing is making people’s eyes aligned again.”

* More coverage and photographes from this conference are available at www.medicalindependent.ie/societies/ico/.