What to do if a child has strabismus and amblyopia? Is surgery needed? Let's see

Beyond appearance, strabismus and amblyopia can impact career choices and daily life. Summer and winter vacations typically see peak periods for strabismus and amblyopia correction, yet many still have concerns. Director Sun Zhaohui provides answers!

01

Partial Manifest Strabismus and Exotropia Usually Require Surgery

Director Sun explains that strabismus is an extraocular muscle disorder where the visual axes of the two eyes are misaligned—when one eye focuses, the other deviates. Strabismus can be congenital or acquired. Congenital cases often appear within six months of birth, while acquired cases may result from trauma, nerve/muscle disorders, or vision impairments like hyperopia or myopia during infancy.

Strabismus classification is complex. Which types require surgery?

Director Sun notes that latent strabismus (heterophoria) involves a tendency for misalignment that the brain can still control to maintain binocular vision, typically not requiring surgery. In contrast, manifest strabismus involves obvious misalignment unmanageable by fusion mechanisms. Some cases, like partially accommodative or non-accommodative esotropia unresponsive to glasses, need surgical correction.

Additionally, exotropia generally requires surgery, as do most congenital esotropia and vertical strabismus.

02

If Strabismus and Amblyopia Coexist, Treat Amblyopia First

Amblyopia ("lazy eye") and strabismus often occur together—hyperopia-induced amblyopia frequently accompanies esotropia, while myopia-related cases may involve exotropia. Untreated amblyopia can lead to lifelong poor vision, lack of stereopsis, and limitations in careers like medicine, driving, or engineering.

Director Sun emphasizes that when both conditions are present, amblyopia must be corrected first. Early strabismus surgery risks disrupting visual balance if patching therapy is later needed for amblyopia, potentially causing new misalignment.

He advises that some strabismus cases are subtle; children over age 3 should undergo vision and alignment checks. Ages 3–7 are optimal for amblyopia treatment. Strabismus timing varies—e.g., congenital esotropia requires intervention before age 1, while intermittent exotropia may need monitoring until stereopsis is affected before surgery.