Lately, there have been cases of children and young people with acquired strabismus associated with the excessive use of electronic devices. Those affected start with an endotrophic and have double vision due to the use of cell phones and screens close (15 or 20 centimeters away or less). Seeing an image so close causes the visual axes to converge on it. Although this is normal, if they remain this way for a long time, they can cause the eyes to begin to truly deviate.
Strabismus, or loss of eye alignment, occurs in two to five percent of the population at some point in their lives. In childhood, especially, people with strabismus are ostracized from some social circle. Teasing has a negative psychosocial impact: children feel isolated, become withdrawn, and even use some cosmetic method to hide the deviated eye, such as covering it with a fringe or wearing glasses.
In these cases, it is necessary to reduce the hours of use of the device and use it according to age. It is recommended, for example, that tablets should not be used before the age of six. However, children often use them, including cell phones for entertainment. This should be forbidden because it can predispose them to present eye deviations.
In some patients, the reduction of their use can make the strabismus disappear. According to the degree of the deviation and the situations that accompany the pathology, it is possible to treat it with botulinum toxin or surgery. First, a refractive error must be ruled out; if there is one, it must be corrected, and then we must see how the deviation behaves.
One recommendation is that every 20 minutes of using a tablet, cell phone, or computer is to pause and rest for 20 seconds looking into the distance (20 feet or six meters), before looking at the screen again. The important thing is prevention and health education, which continues to fail in Mexico. Some patients arrive late for consultation, so the recommendation is that if I suspect I have a deviated eye or I see that my child, relative or friend has it, it is preferable to see an ophthalmologist.
Types of strabismus
There are several types of this disorder: congenital strabismus (born with ocular deviation or presented in early stages in infants) and acquired strabismus, which causes double vision and is associated with cranioencephalic trauma, chronic pathologies, and, lately, prolonged exposure to electronic devices due to forced confinement due to the COVID-19 pandemic.
In most cases the direct cause of congenital strabismus is unknown, as it is multifactorial; however, sometimes it is due to failure in the development of a nerve or extraocular muscles. Strabismus in infants is generally related to risk factors such as abnormal delivery, low birth weight, or being the child of a smoking mother, among others.
In childhood, generally in the first year of life, the so-called congenital defects occur (the most frequent is endotrophic, the inward deviation of the eyes). These are patients who are not born with the deviation. Suddenly, one or both eyes deviate.
There are also those called accommodative, which occur between three and four years of age; they are intermittent deviations. When the child pays attention to something, the eyes begin to deviate, but when he/she does not pay attention, they are straight.
They are so-called because they are related to hypermetropia and because when the patient is prescribed glasses, the eyes straighten. There is also strabismus which is a mixture of congenital and accommodative, which is not completely corrected with the use of glasses and requires surgery to treat the residual degree of deviation. The latter is known as partially accommodative.
There are also those known as exotropia, which causes the eyes to drift outward, intermittently, i.e., alternating periods of straight eyes with stages of deviated eyes, usually when not paying attention to something. These cases are usually treated with surgery.
In adults, it is mainly associated with systemic diseases such as diabetes and hypertension, and cranioencephalic traumas due to accidents.
When the deviation is caused by trauma, it is necessary to wait approximately three to six months to observe if there is recovery; otherwise, it is corrected with surgery. In the case of strabismus caused by diabetes, glucose is controlled and the deviation corrects itself. If this does not happen in six months, surgery is also applied.
Other types of strabismus in adults are secondary and are linked to other conditions, such as thyroid disorders or intracranial tumors. Some are hereditary, such as congenital fibrosis of extraocular muscles, but they are rare.
Not all people with strabismus see double. In congenital and early developmental strabismus there is a sensory adaptation of the brain to cancel the image of the deviated eye. However, when this organ reaches maturity (after two or three years of age), it is not so easy to annul it. Then double vision or diplopia occurs, so that when a person sees double, we are dealing with acquired strabismus, explains the UNAM academic, Jessica Vargas.