Editing Strabismus (section)

== Signs and symptoms ==
{{multiple image
| width     = 115
| image1    = Autostereogram normal vergence.svg
| alt1      = Aligned vergence; how one ideally views objects
| caption1  = {{center|Aligned&nbsp;[[vergence]]}}
| image2    = Autostereogram cross-eyed vergence.svg
| alt2      = Esotropia
| caption2  = {{center|[[Esotropia]]}}
| image3    = Autostereogram wall-eyed vergence.svg
| alt3      = Exotropia
| caption3  = {{center|[[Exotropia]]}}
}}

When observing a person with strabismus, the misalignment of the eyes may be quite apparent. A person with a constant eye turn of significant magnitude is very easy to notice. However, a small magnitude or intermittent strabismus can easily be missed upon casual observation. In any case, an [[eye care professional]] can conduct various tests, such as cover testing, to determine the full extent of the strabismus.{{citation needed|date=July 2022}}

Symptoms of strabismus include [[diplopia|double vision]] and [[asthenopia|eye strain]]. To avoid double vision, the brain may adapt by [[Suppression (eye)|ignoring one eye]]. In this case, often no noticeable symptoms are seen other than a minor loss of depth perception. This deficit may not be noticeable in someone who has had strabismus since birth or early childhood, as they have likely learned to judge depth and distances using [[Monocular depth cues|monocular cues]]. However, a constant unilateral strabismus causing constant suppression is a risk for [[amblyopia]] in children. Small-angle and intermittent strabismus are more likely to cause disruptive visual symptoms. In addition to headaches and eye strain, symptoms may include an inability to read comfortably, fatigue when reading, and unstable or "jittery" vision.

=== Psychosocial effects ===
{{See also|Stereopsis#Prevalence and impact of stereopsis in humans|l1=Prevalence and impact of reduced stereopsis in humans}}
[[File:Fayum-40.jpg|thumb|upright|[[Fayum mummy portraits|Fayum mummy portrait]], {{Circa|150–200 AD}}]]
[[File:Inghirami Raphael.jpg|thumb|upright|[[Tommaso Inghirami]]]]
[[File:Norma Shearer 1926.jpg|thumb|upright|[[Norma Shearer]]]]
[[File:Alger_Hiss_(1950).jpg|thumb|upright|[[Alger Hiss]]]]
[[File:Sartre_1967_crop.jpg|thumb|upright|[[Jean-Paul Sartre]]]]
[[File:Marty Feldman 1972.JPG|thumb|upright|[[Marty Feldman]]]]
[[File:Hannah-Hampton.jpg|thumb|175x175px|[[Chelsea F.C. Women|Chelsea]] goalkeeper [[Hannah Hampton]] has strabismus.]]
People of all ages who have noticeable strabismus may experience psychosocial difficulties.<ref name="satterfield-et-al-1993">{{cite journal | vauthors = Satterfield D, Keltner JL, Morrison TL | title = Psychosocial aspects of strabismus study | journal = Archives of Ophthalmology | volume = 111 | issue = 8 | pages = 1100–5 | date = August 1993 | pmid = 8166786 | doi = 10.1001/archopht.1993.01090080096024 }}</ref><ref name="olitsky-et-al-1999">{{cite journal | vauthors = Olitsky SE, Sudesh S, Graziano A, Hamblen J, Brooks SE, Shaha SH | title = The negative psychosocial impact of strabismus in adults | journal = Journal of AAPOS | volume = 3 | issue = 4 | pages = 209–11 | date = August 1999 | pmid = 10477222 | doi = 10.1016/S1091-8531(99)70004-2 }}</ref><ref name="uretmen-et-al-2003">{{cite journal | vauthors = Uretmen O, Egrilmez S, Kose S, Pamukçu K, Akkin C, Palamar M | title = Negative social bias against children with strabismus | journal = Acta Ophthalmologica Scandinavica | volume = 81 | issue = 2 | pages = 138–42 | date = April 2003 | pmid = 12752051 | doi = 10.1034/j.1600-0420.2003.00024.x | doi-access = free }}</ref> Attention has also been drawn to potential socioeconomic impact resulting from cases of detectable strabismus. A socioeconomic consideration exists as well in the context of decisions regarding strabismus treatment,<ref name="satterfield-et-al-1993" /><ref name="olitsky-et-al-1999" /><ref name="uretmen-et-al-2003" /> including efforts to re-establish binocular vision and the possibility of [[stereopsis recovery]].<ref>See peer discussion in: {{cite journal | vauthors = Mets MB, Beauchamp C, Haldi BA | title = Binocularity following surgical correction of strabismus in adults | journal = Transactions of the American Ophthalmological Society | volume = 101 | pages = 201–5; discussion 205–7 | year = 2003 | issue = 5 | pmid = 14971578 | pmc = 1358989 | doi = 10.1016/j.jaapos.2004.07.003 }}</ref>

One study has shown that strabismic children commonly exhibit behaviors marked by higher degrees of inhibition, anxiety, and emotional distress, often leading to outright emotional disorders. These disorders are often related to a negative perception of the child by peers. This is due not only to an altered aesthetic appearance but also because of the inherent symbolic nature of the [[eye]] and [[gaze]] and the vitally important role they play in an individual's life as social components. For some, these issues improved dramatically following [[strabismus surgery]].<ref>{{cite journal | vauthors = Bernfeld A | title = [Psychological repercussions of strabismus in children] | language = fr | journal = Journal Français d'Ophtalmologie | volume = 5 | issue = 8–9 | pages = 523–30 | year = 1982 | pmid = 7142664 | trans-title = Psychological repercussions of strabismus in children }}</ref> Notably, strabismus interferes with normal [[eye contact]], often causing [[embarrassment]], [[anger]], and feelings of awkwardness, thereby affecting social communication in a fundamental way, with a possible negative effect on [[self esteem]].<ref>{{cite web |url=http://www.allaboutvision.com/conditions/strabismus.htm |title=Strabismus |website=All About Vision |publisher=Access Media Group |url-status=live |archive-url=https://web.archive.org/web/20140916142449/http://www.allaboutvision.com/conditions/strabismus.htm |archive-date=September 16, 2014  }}</ref><ref>Estes, K. J., Parrish, R. K., Sinacore, J., Mumby, P. B., & McDonnell, J. F. (2020). Effects of corrective strabismus surgery on social anxiety and self-consciousness in adults. Journal of AAPOS : the official publication of the American Association for Pediatric Ophthalmology and Strabismus, 24(5), 280.e1–280.e4. https://doi.org/10.1016/j.jaapos.2020.05.017</ref>

Children with strabismus, particularly those with [[exotropia]], an outward turn, may be more likely to develop a mental health disorder than normal-sighted children. Researchers have theorized that esotropia (an inward turn) was not found to be linked to a higher propensity for mental illness due to the age range of the participants, as well as the shorter follow-up time period; esotropic children were monitored to a mean age of 15.8&nbsp;years, compared with 20.3&nbsp;years for the exotropic group.<ref>{{cite journal | vauthors = Tonge BJ, Lipton GL, Crawford G | title = Psychological and educational correlates of strabismus in school children | journal = The Australian and New Zealand Journal of Psychiatry | volume = 18 | issue = 1 | pages = 71–7 | date = March 1984 | pmid = 6590030 | doi = 10.3109/00048678409161038 | s2cid = 42734067 }}</ref><ref>{{cite journal | vauthors = Mohney BG, McKenzie JA, Capo JA, Nusz KJ, Mrazek D, Diehl NN | title = Mental illness in young adults who had strabismus as children | journal = Pediatrics | volume = 122 | issue = 5 | pages = 1033–8 | date = November 2008 | pmid = 18977984 | pmc = 2762944 | doi = 10.1542/peds.2007-3484 }}</ref>

Investigations have highlighted the impact that strabismus may typically have on quality of life.<ref>{{cite journal | vauthors = Beauchamp GR, Felius J, Stager DR, Beauchamp CL | title = The utility of strabismus in adults | journal = Transactions of the American Ophthalmological Society | volume = 103 | pages = 164–71; discussion 171–2 | date = December 2005 | pmid = 17057800 | pmc = 1447571 }}</ref> Studies in which subjects were shown images of strabismic and non-strabismic persons showed a strong negative [[bias]] towards those visibly displaying the condition, clearly demonstrating the potential for future [[socioeconomic]] implications with regard to [[employability]], as well as other [[#Psychosocial effects|psychosocial effects]] related to an individual's overall happiness.<ref>{{cite journal | vauthors = Mojon-Azzi SM, Mojon DS | title = Strabismus and employment: the opinion of headhunters | journal = Acta Ophthalmologica | volume = 87 | issue = 7 | pages = 784–8 | date = November 2009 | pmid = 18976309 | doi = 10.1111/j.1755-3768.2008.01352.x | doi-access = free }}</ref><ref>{{cite journal | vauthors = Mojon-Azzi SM, Mojon DS | title = Opinion of headhunters about the ability of strabismic subjects to obtain employment | journal = Ophthalmologica. Journal International d'Ophtalmologie. International Journal of Ophthalmology. Zeitschrift für Augenheilkunde | volume = 221 | issue = 6 | pages = 430–3 | date = October 2007 | pmid = 17947833 | doi = 10.1159/000107506 | s2cid = 29398388 | url = https://boris.unibe.ch/28257/ }}</ref>

Adult and child observers perceived a right heterotropia as more disturbing than a left heterotropia, and child observers perceived an esotropia as "worse" than an exotropia.<ref>{{cite journal | vauthors = Mojon-Azzi SM, Kunz A, Mojon DS | title = The perception of strabismus by children and adults | journal = Graefe's Archive for Clinical and Experimental Ophthalmology = Albrecht von Graefes Archiv für Klinische und Experimentelle Ophthalmologie | volume = 249 | issue = 5 | pages = 753–7 | date = May 2011 | pmid = 21063886 | doi = 10.1007/s00417-010-1555-y | s2cid = 10989351 | url = http://doc.rero.ch/record/312008/files/417_2010_Article_1555.pdf }}</ref> Successful surgical correction of strabismus, for adult as well as children, has been shown to have a significantly positive effect on psychological well-being.<ref>{{cite journal | vauthors = Burke JP, Leach CM, Davis H | title = Psychosocial implications of strabismus surgery in adults | journal = Journal of Pediatric Ophthalmology and Strabismus | volume = 34 | issue = 3 | pages = 159–64 | date = May 1997 | doi = 10.3928/0191-3913-19970501-06 | pmid = 9168420 }}</ref><ref>{{cite journal | vauthors = Durnian JM, Noonan CP, Marsh IB | title = The psychosocial effects of adult strabismus: a review | journal = The British Journal of Ophthalmology | volume = 95 | issue = 4 | pages = 450–3 | date = April 2011 | pmid = 20852320 | doi = 10.1136/bjo.2010.188425 | s2cid = 206870079 | url = https://hal.archives-ouvertes.fr/hal-00577963/file/PEER_stage2_10.1136%252Fbjo.2010.188425.pdf }}</ref>

Very little research exists regarding [[Coping (psychology)|coping]] strategies employed by adult strabismics. One study categorized coping methods into three subcategories: avoidance (refraining from participation in an activity), distraction (deflecting attention from the condition), and adjustment (approaching an activity differently). The authors of the study suggested that individuals with strabismus may benefit from psychosocial support such as [[interpersonal skills]] training.<ref>{{cite journal | vauthors = Jackson S, Gleeson K |title=Living and coping with strabismus as an adult |journal=European Medical Journal Ophthalmology |date=August 2013 |volume=1 |pages=15–22 |url=http://emjreviews.com/therapeutic-area/ophthalmology/living-coping-strabismus-adult/ |url-status=live |archive-url=https://web.archive.org/web/20170621025330/http://emjreviews.com/therapeutic-area/ophthalmology/living-coping-strabismus-adult/ |archive-date=June 21, 2017  }}</ref> No studies have evaluated whether psychosocial interventions have had any benefits on individuals undergoing strabismus surgery.<ref name="MacKenzie">{{cite journal | vauthors = MacKenzie K, Hancox J, McBain H, Ezra DG, Adams G, Newman S | title = Psychosocial interventions for improving quality of life outcomes in adults undergoing strabismus surgery | journal = The Cochrane Database of Systematic Reviews | volume = 2016 | issue = 5 | pages = CD010092 | date = May 2016 | pmid = 27171652 | doi = 10.1002/14651858.CD010092.pub4 | pmc = 9250695 | url = http://openaccess.city.ac.uk/19311/1/MacKenzie_et_al-2016-.pdf }}</ref>