Question

I am 18 years old. I have congenital exotropia (not hereditary, as far as I've been told) and an amblyotropic left eye. I use the right eye for focusing on objects, for reading, writing, watching TV, drawing...; all I use my left eye for is 'viewing the landscape', for 'general purpose viewing'. Thus it has grown pretty lazy. I don't think I have strabismus in only one eye, for as I look through the right eye the left one points slightly up and outwards, and the same happens with the right eye when I look through the left one (I don't do this much).
I remember being about 9 years when first I looked straight at the mirror and realized I could bring both eyes straight forward with some effort. I've been doing this ever since, looking straight at people's eyes and using them as 'reference marks'. My problem has always bothered me immensely and by doing this at least I look more normal (some people don't even notice I've got strabismus), but it strains my eyes so that I can't look that way for three minutes without now and then having to rest my vision upon something on the ground. I've never been informed whether this is harmless or not, but it is the only way to look almost normal... Now comes the drama. I was about 3 when I started using glasses (for myopia only) but I didn't use them for a long time. I was bothered by them and my father always let me remove them, so I quit soon. He was scared to death of submitting me to a surgery, and I, as a 4, 5 year old would do, cried whenever the doctors brought up the subject. So the story went. I remember trying to use glasses for myopia a few times, but I never kept them for more than a year or so. I haven't been using them since I was 12. My right eye is 'wonderful', in my own words (I must have little myopia there), while my left one is 'awful'; so I went through the years using primarily the right eye, and looking at people forcing the eyes straight. Now I am finally convincing my parents I am in desperate need for a surgery (I'm tired of worrying about people noticing my squint or not, and sick and tired of postponing romance until I'm 'cured'). I have some doubts I'd like to wipe from my overloaded head: Can a surgery really work AT FIRST TRY? My problem doesn't bother me much functionally, but is a pain in the ass cosmetically. Everybody says I've got beautiful green eyes, and I do like them - straight.
I never saw double. Can it happen then?
Is there the least possibility to acquire a better vision for my amblyopic left eye or will I be condemned to using glasses or contact lenses? When I bring both eyes straight, I get *very* near-sighted. Will it happen after a surgery or does it happen out of strain? I am aware I will never see real 3D, but will it be a severe handicap when I start driving? Will I tumble down stairs for the next few months after the surgery or is it a matter of days? I am terrified of local anesthesy and I know general anesthesy can bring out that PONV thing. I can handle it. But will I have severe headaches for a long time after the surgery? Wow, thank you very much in advance. I am relieved there is room for us squints on the net, so that we can skip the traumatic process of telling our dramas and asking our questions live. I only hope you can handle mine soon... :)

(Amanda)

Answer:

Dear Amanda,

You seem to have an outward squint, in combination with myopia and an amblyopic left eye. You are able to straighten your eyes momentarily by focusing and converging excessively. As looking with one eye results in the other eye going up you most likely have "dissociated vertical deviation" which occurs only in patients that squint from birth. Have yourself examined and operated by an ophthalmologist that does a lot of strabismus surgery. Most likely he will lengthen the outer muscle of the left eye and shorten the inner muscle of the left eye and, in your case, that seems certainly worthwhile. The chance that the divergent squint recurs years after successful surgery is appreciable, about one in three on a lifetime basis. It simply has a tendency to increase with age, nobody knows why. Don't worry about problems with driving, tumbling down stairs or headaches in advance, chances there are only slight.

Yours truly,

(Herb Simonsz, MD, PhD)

Note: To contact contributors to this page, replace [AT] in the e-mail address by @.