Strabismus Treatment Program

Strabismus, clinically referred to as ocular misalignment, and commonly known as “crossed eyes” or “eye misalignment,” is a condition characterized by the inability of both eyes to maintain coordinated and parallel positioning during visual fixation. This results in one eye deviating from the intended line of sight—turning inward, outward, upward, or downward—while the fellow eye remains properly aligned. The misalignment may present continuously or only intermittently, depending on the underlying neuromuscular control of ocular motility. Though strabismus can manifest at any age, it is most frequently identified during early childhood, coinciding with critical periods of visual development.

From a physiological standpoint, normal binocular vision requires the precise synchronization of six extraocular muscles in each eye, governed by complex neurological pathways. In strabismus, a disruption in the balance or coordination of these muscles interferes with fusion—the brain’s ability to merge images from both eyes into a single, coherent visual experience. As a result, visual input from the misaligned eye may be actively suppressed by the brain in order to avoid confusion or diplopia (double vision), particularly in younger individuals whose visual systems are still developing.

When left uncorrected, strabismus can lead to significant visual complications. The most common long-term consequence is amblyopia, or functional vision loss in the deviated eye due to prolonged neural suppression. Additionally, persistent misalignment disrupts stereopsis, the brain’s capacity to perceive depth based on the subtle differences in images received from both eyes. Over time, this can affect spatial judgment, visual tracking, and overall coordination. Beyond the physiological impact, strabismus can also have psychosocial and quality-of-life implications, especially in pediatric and adolescent populations, where eye contact and facial symmetry play critical roles in interpersonal interaction and self-esteem.

Why Cuba

Strabismus surgery in Cuba is performed by highly trained ophthalmic surgeons who specialize in ocular motility and binocular vision disorders by realigning the eyes while optimizing both functional outcomes and cosmetic appearance. Given the impact of strabismus on visual development, depth perception, and quality of life, Cuban ophthalmology teams conduct comprehensive preoperative assessments, evaluating ocular motility patterns, binocular function, and neuromuscular coordination to determine the most appropriate surgical approach for each individual.

Cuban eye care institutions offer both traditional and adjustable suture techniques, with procedures tailored to the patient’s age, degree of deviation, and specific muscular involvement. In adult cases, adjustable suture surgery is frequently utilized to allow for fine-tuning of eye alignment in the immediate postoperative period, enhancing precision and patient satisfaction. Pediatric interventions are approached with sensitivity to visual developmental stages, ensuring minimal disruption to the maturing visual system.

Causes of Strabismus

Strabismus occurs when the neuromuscular control of eye movement is disrupted, leading to imbalanced positioning of the eyes. Normally, six muscles control the movement of each eye, working in harmony to keep both eyes aligned. In individuals with strabismus, one or more of these muscles may be too strong or too weak, or the neurological control system may not function properly.

The underlying causes of strabismus vary and may include:

• Genetic predisposition
• Congenital factors (present at birth)
• Neurological disorders (e.g., cerebral palsy, stroke)
• Refractive errors (especially uncorrected farsightedness)
• Trauma to the eye or orbit
• Eye muscle or cranial nerve dysfunction
• Systemic illnesses (e.g., thyroid eye disease)

In children: Strabismus is often linked to developmental delays or hereditary factors.

In adults: Strabismus may result from injury, disease, or decompensation of a previously stable condition.

Effect of Strabismus on Eye Health

Strabismus can severely impact binocular vision—the brain’s ability to combine images from both eyes into a single, coherent picture. If untreated, this may result in:

• Amblyopia (lazy eye): Reduced vision in the misaligned eye due to lack of stimulation
• Diplopia (double vision): Perception of two images of the same object
• Depth perception loss: Impaired ability to judge distances
• Eye strain and headaches: Often result from the constant effort to maintain binocular alignment and visual focus.
• Psychosocial effects: Including reduced self-confidence, especially in children

Types and Classification of Strabismus

Strabismus can be categorized based on the direction of eye misalignment:

• Esotropia: Inward turning of the eye
• Exotropia: Outward turning of the eye
• Hypertropia: Upward turning of the eye
• Hypotropia: Downward turning of the eye
• Cyclotropia: Rotational misalignment of the eye

It may also be classified by:

• Onset: Congenital (infantile) or acquired
• Frequency: Constant or intermittent
• Laterality: Unilateral (one eye) or alternating (both eyes, one at a time)
• Comitancy: Comitant (angle of deviation remains constant in all directions) or incomitant (angle changes with direction of gaze)

Symptoms of Strabismus

The symptoms of strabismus can vary depending on age and severity. Common signs include:

• Misaligned or drifting eyes
• Frequent squinting or head tilting
• Closing one eye in bright light
• Poor depth perception
• Double vision (especially in adults)
• Eye fatigue or discomfort

Diagnosis of Strabismus

A thorough ophthalmologic examination is required to diagnose strabismus. The evaluation typically includes:

• Visual acuity testing
• Ocular alignment assessments (cover tests, Hirschberg test)
• Refraction test to determine refractive errors
• Retinal examination to rule out underlying pathology
• Neurological assessment, if needed
• Additional imaging, such as MRI or CT scans, may be indicated if a neurological cause is suspected.

Types of Procedures and Surgical Techniques

Strabismus surgery involves adjusting the length or position of the extraocular muscles to realign the eyes.

Surgical intervention is considered when:

• Non-surgical treatments (e.g., glasses, patching, or vision therapy) fail
• There is a significant cosmetic or functional impact
• Strabismus is causing amblyopia or double vision
• Eye alignment cannot be controlled with prism lenses or exercises

Candidates must be in overall good health and undergo a comprehensive pre-operative evaluation. In children, early surgical correction can enhance visual development and prevent long-term vision problems.

Procedures for strabismus include:

• Muscle Recession: Weakening the pull of an overactive muscle by detaching it and reattaching it further back on the eye.

• Muscle Resection: Strengthening a weak muscle by removing a section and reattaching it closer to the original point.

• Adjustable Suture Surgery: Common in adults; allows post-operative adjustment of muscle position under local anesthesia.

• Transposition Surgery: Repositions muscles in cases of nerve palsy or limited movement.

All surgeries are typically performed under general anesthesia in children and local or conscious sedation in adults.