Monday, June 21, 2010

Strabismus: The case of the wandering eye

I have a post coming up on one of my blogs soon about how asthma is not just a disease of the lungs, but a disease that effects the entire body.

For example, to go with my asthma I also been diagnosed with allergies, rhinitis, sinusitis, ear infections, conjunctivitis, GERD, deviated nasal septum, and even strabismus. In my case, as you can see from the picture, I have Walleyes. Actually, only one of my eyes appears to be out of alignment, and my doctor refers to it as exotropy (one eye wanders away from the nose).

Many of the above you can easily associate with asthma. The deviated septum is a greater stretch, although studies have shown asthmatics with allergies have a tendency to pick up sinusitus and rhinitis often, and the constant inflammation and irritation and rubbing often results in a nasal crease and, you guessed it, deviated septums.

Of course that problem was repaired long ago. Another problem that was repaired long ago and has made a comeback is strabismus. This is where my brain has lost contact with my eyeballs. My brain only has the ability to focus from one eye, and the other eye sort of drifts off, thus the common nickname wandering eye or lazy eye.

A better way of explaining it is to picture the front wheel bearings of a car. Your eyes, like your front tires, turn in unison as you move the steering wheel. If the left wheel is crooked, and you straighten it out, the right tire will be crooked. That's about how my eyes work.

The major problem with strabismus is the ability to focus. My doctor has actually said my vision for each eye is great for my age (20/20), yet I do not have the ability to focus. I have no depth perception. I have lost my ability to see in 3D. And, when I'm tired, I see double. This happened just last evening when I was playing catch with my son. I had to quit before I got donked on the head. describes strabismus in this way:
Strabismus is a functional defect where the eyes are misaligned and point in different directions. The brain’s ability to see three-dimensional objects depends on proper alignment of the eyes. When both eyes are properly aligned and aimed at the same target, the visual portion of the brain fuses the forms into a single image. When one eye turns inward, outward, upward, or downward, two different pictures are sent to the brain. This causes loss of depth perception and binocular vision. The turned eye may be straight at times, and the misalignment may come and go. Strabismus occurs in about 4 percent of all children in the United States, equally in males and females, and is sometimes hereditary. The condition can also develop later in life.

In young children with any form of strabismus, the brain may learn to ignore the misaligned eye’s image and see only the image from the best-seeing eye. This is called amblyopia, or lazy eye, and results in a loss of depth perception. When an adult develops strabismus, double vision sometimes occurs because the brain has already been trained to receive images from both eyes and cannot ignore the image from the turned eye.
Actually, I find that I sometimes see double, especially when I'm tired. Yet I also see out of one eye at a time. This is probably because I have had bouts of strabismus my entire life. I've had surgery to correct it three times before now. (July 1, 2010, was my 4th corrective surgery)

I first started noticing this a while back when I was doing breathing treatments and when I squirted the vial of medicine into the cup I kept missing the cup. Then one morning I dished out scrambled eggs, and I missed all the plates.

Harmless things, yet if your driving and all of a sudden you see a tree in the middle of the road, that's not so good. This occurs because while I'm looking at the road with my dominant left eye, my right eye is busy looking at the trees along the right side of the car. My brain picks up what both eyes are seeing, and thus the tree in the middle of the road that ain't there.

Now this has yet to pose a problem, as I just keep driving knowing the tree is not really there. Yet you can see how this might pose a problem. Plus what I just described is a rare and worse case scenario. Although it has occurred for split seconds.

Ironically, this has not effected my ability to draw blood gases. This is because as I'm getting ready to poke I concentrate hard and focus. My ABG success rate remains high until after 6 a.m. at which time it drops to a 90% success rate. At least that's how I've always explained it to my co-workers.

Now you might be saying: what is the connection between strabismus and asthma? Well, there is no proven link. Although from my review of historical text I've observed many asthmatics also have eye trouble.

Now this is not based on science, yet I would hypothesize as to whether all the bouts of conjunctivitis, and all the bouts of rhinitis (which is hay fever) have effected my eyes. Kind of like the way the deviated septum may have occurred due to constant rubbing of my nose, the crooked eye may be the result of constant rubbing of my eyes.

Despite my non scientific theory of what causes asthma, here is what has to say about the cause of strabismus:

"Many things and/or events can cause a strabismus. They include genetics, inappropriate development of the "fusion center" of the brain, problems with the controlled center of the brain, injuries to muscles or nerves or other problems involving the muscles or nerves. Surprisingly, most cases of strabismus are not a result of a muscle problem, but are due to the control system -- the brain."
Of course I can't see this fact disproving my theory that rubbing of the eyes can cause strabismus. After all, rubbing is some form of "injury" to the muscles or nerves.

Or, according to, it's caused by, "unequal pulling of muscles on one side of the eye or a paralysis of the ocular muscles." This definition also doesn't disprove my theory.

I remember when I was a kid having this same surgery when I was 2 in 1972, 10 in 1980 and 15 in 1985. I can't remember which eye was operated on those times, yet I remember parts if not all of them -- including when I was 2 believe it or not.

I remember my parents were not allowed to stay, and I remember having to sleep in a crib and I remember my parents saying goodbye. I also remember leaving the hospital in a wheelchair and my brothers saying, "Why can't I ride in the chair?"

Back when I was about 8 or 9 I remember walking with one eye shut all the time. Now, as an adult, as I do the same thing, I realize why I do this. It's the same as my tree in the middle of the road example above. When it's really sunny out, you focus on the ground before you, and face away from the sun as to not get the glare. Yet, while my left eye does this, the other is facing the sun. Hence, this eye is shut.

I do this instinctively. I discussed this with my doctor, and he said walking around with one eye shut is the first sign of strabismus in kids.

In my review of this disease, I've learned that other famous people had it, including Abraham Lincoln. I knew he and I had to have something in common other than being great thinkers.

So, in a few weeks, I'm going to have this fixed for the 4th time. I'm not excited about it, although I'm looking forward to seeing right. So if I disappear from the blogsphere for a while in the first few weeks of July, now you know why.

Follow my strabismus surgery journey:


  1. Hi! I am Cherryl from the Philippines. My 19 month old baby was diagnosed with alternating esotropia when she was about 5 months old. Just February of this year, she underwent strabismus surgery. The alignment remained for 2 months and started to drift again on days that follow. Her condition affected me so much that not a single day would pass that I worry about her. I am deeply concern how she'll handle her condition when she grows up. I am fully aware that to it takes multiple surgeries to come up with close to perfect results yet I can not help but be frustrated and worried again at this point. I try to read as many blogs as I can regarding individuals experiencing the same condition. I pray that everything will turn out fine for you and my baby. :-)

  2. Tabelley: Don't worry about your baby. It sometimes takes more than one surgery to correct this ailment, which is what happened with me.

    Even if you can't afford the surgery, you can live a normal life with it. I did for several years several times.

    I actually feel thankful this is my fate, because I can think of far worse things that could have happened.

    If nothing else, it will give your child super peripheral vision.

  3. Have you considered doing vision therapy to correct this? I'd recommend consulting a developmental optometrist. In "Fixing My Gaze" neurobiologist Sue Barry tells the story of how through vision therapy she gained depth perception/3D vision (stereoscopy) at age 48 (surgeries made her eyes look straight, but her brain/eyes needed vision therapy to learn how to work together). Check it out, very inspiring. It's the reason my two-year-old daughter is doing vision therapy, with much success.

  4. Thanks for the tip. If the problem comes back...