Indications for Strabismus Surgery

Abstract

Traditionally, the goal of strabismus treatment has been to realign the visual axes in order to eliminate diplopia, or to produce, maintain, or restore binocular vision. Additionally, surgery to improve an abnormal head posture, eliminate abnormal eye movements, or simply to restore the normal anatomical position of the eyes are well-accepted indications for surgery. Facilitation of the development of binocular vision is classically demonstrated in the treatment of idiopathic infantile esotropia (congenital esotropia). Historically, Worth’s sensory concept of congenital esotropia proposed a disorder that resulted from a deficit in the “fusion center” within the central nervous system. According to this theory, the goal of producing binocular vision was hopeless. He theorized that it was not possible to restore this congenitally absent neural function. Data supporting Worth’s theory were obtained at a time when strabismus surgery was rarely performed prior to the age of 2 years. Until the 1960s the results of surgical treatment of patients with congenital esotropia almost universally supported this pessimistic view.