The medical term for misaligned eyes is strabismus. But in the Philippines, those whose eyes turn inward are referred to as “duling” (esotropia), while those with outward-turning eyes are called “banlag” (exotropia).
The condition does not just result in double vision and problems with depth perception—which affect one’s ability to read, drive, or play sports—but it also impacts an individual’s entire life.
Children with strabismus become the butt of endless teasing and jokes, making them withdrawn, self-conscious, and the target of bullying. As adults, their low self-esteem and visual challenges are reflected in their limited job opportunities, relationships, and overall quality of life.
So what causes strabismus? More importantly, can anything be done about it?
Brain-muscle connection
In a 2021 report by the National Institute of Health, strabismus affects an estimated 3.11% of children aged six (6) to eight (8) years old in the Philippines. According to the study, exotropia (banlag) was more prevalent than esotropia (duling), with a ratio of 9.75: 1.
Strabismus, which can also present vertically as one eye looking upward (hypertropia) or one eye looking downward (hypotropia) “is usually due to a problem that comes either from the brain or the nerves that come out from the brain and go into the eye muscles,” says Mary Rose Teodoro-Chang, MD, Pediatric Ophthalmologist from Makati Medical Center (MakatiMed).
Conditions like cerebral palsy, Down syndrome, and Graves’ disease can also lead to strabismus, as can stroke, a head injury, brain tumor, and weak vision in one eye (otherwise known as lazy eye or amblyopia).
Ways to diagnose Strabismus
Because some newborns and infants show signs of strabismus that they eventually outgrow, a proper diagnosis is key. Dr. Teodoro-Chang relies on the light reflex test, which involves shining a penlight into a patient’s eyes to check for alignment based on the position of the light’s reflection on the corneas.
Doctors also use an ophthalmoscope to perform the red reflex test that checks for asymmetry. Then there is the cover test, or covering one eye to observe movement of the uncovered eye. A photo screener is also used to determine the grade of a patient’s eyes.In fact, knowing a patient’s eye grade is the start of correcting strabismus. “Sometimes, a child really needs glasses, and we have to make sure that their vision is even,” shares the MakatiMed doctor. In the event that one eye remains weak despite glasses, there is patching, or covering the stronger eye to strengthen the lazy eye.
Other treatment options are prism lenses in glasses, which bend light rays, redirecting the images seen by the misaligned eye; and Botox, which weakens an overactive eye.
Strabismus surgery
The doctor points out that breast milk contains 90% water and 10% nutrients in the right amount necessary for an infant to grow healthy during the first six (6) months of life.a
In strabismus surgery, doctors surgically strengthen or weaken muscles in the eyes. It takes about an hour and can be performed as an outpatient or in-patient procedure using local or general anesthesia.
Give yourself two (2) to three (3) days to recuperate, says Dr. Teodoro-Chang, and one day to see the desired symmetry. “Sometimes it takes six (6) weeks for it to be perfectly aligned,” she notes. “But in some patients, it is already perfectly aligned the next day.”
Comprehensive tests and treatments related to vision are offered at MakatiMed’s Eye Care Center. From common conditions like cataract, glaucoma, and age-related macular degeneration to dry eye disease, diabetic retinopathy, and strabismus, the Eye Care Center addresses these and other cases with accurate diagnosis and the latest procedures. Improving, restoring, and maintaining vision are the goals of the center’s experienced, board-certified Ophthalmologists.
“There is hope. You have a choice. Do not think that there is nothing you can do about it,” underlines Dr. Teodoro-Chang to those who have tolerated strabismus and various forms of compromised vision for years. “For adults who have been suffering from it, see us so we can check if your condition can be improved and it is not so obvious. For children, get regular checkups. If you see something’s not right with your child, do not wait long to see a doctor.”
“MakatiMed is the hospital with a heart. Here, it is really a service,” she adds. “So, whatever we can do for you, we are here—pediatric ophthalmologists, ophthalmologists, and other doctors. You can reach out to us.”
Article based on the Doctors on TV episode featuring Mary Rose Teodoro-Chang, MD last August 6, 2023.
MakatiMed Eye Care Center (Dr. Carlos L. Sevilla Center) is located on the 6th Floor, Tower 2. It is open Mondays to Saturdays from 8AM to 5PM, and on holidays from 8AM to 4PM. You may reach them at (+632) 8888 8999 locals 3610 and 3611 or [email protected].
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