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FUNCTIONAL AND STRUCTURAL CAUSES OF SECONDARY STRABISMUS IN
CLINICAL OPHTHALMOLOGY
Ibragimova Savrinisa Nazirjanovna
ophthalmologist of the Meridian clinic, Central Asian Medical University, doctor of the
highest category
Abstract:
Secondary strabismus is an acquired disorder of eye coordination and position
caused by multiple systemic, neurological, and mechanical factors. This pathology differs
from congenital strabismus by its later onset, frequent development of diplopia, and
impaired binocular vision. The article analyzes the main etiologic factors, including
traumatic brain injury, vascular lesions, neurological disorders, ophthalmic surgery, and
dysfunction of the oculomotor muscles and cranial nerves. Modern diagnostic methods, such
as visual assessment, prismatic correction, neuroimaging, and electrophysiological tests, are
considered. Attention is paid to therapeutic strategies: orthoptic rehabilitation, botulinum
toxin administration, surgical methods, and systemic treatment of the underlying disease.
Particular importance is attached to a multidisciplinary approach and early intervention
aimed at optimizing visual functions and improving the quality of life of patients.
Keywords:
secondary strabismus, acquired strabismus, diplopia, amblyopia, cranial nerve
palsy, oculomotor muscles, prismatic correction, botulinum toxin, orthoptic therapy,
strabismus surgery, neuro-ophthalmology, systemic diseases, visual rehabilitation.
Introduction
Strabismus (strabismus) is a common ophthalmological disorder characterized by the
inability of the eyes to maintain synchronous gaze direction, which leads to impaired
binocular vision and, as a consequence, to diplopia and amblyopia. Congenital strabismus,
diagnosed mainly in childhood, has been studied quite well. Secondary (acquired)
strabismus manifests itself at a more mature age and has a variety of etiological factors
associated with systemic and neurological pathologies. The global prevalence of strabismus
ranges from 2–5%, with secondary forms accounting for a significant percentage among
adult patients. According to a meta-analysis by Friedman et al. (2017), about 15–20% of all
cases of strabismus are acquired forms. The incidence of secondary strabismus increases
among individuals with vascular and neurological pathologies — stroke, multiple sclerosis,
diabetic neuropathy, which is caused by damage to the oculomotor nerves and muscles. In
countries with limited access to ophthalmological care and diagnostics, the incidence of
secondary strabismus is lower, but traumatic causes are especially relevant here. Modern
methods of neuro-ophthalmological diagnostics and therapy help improve the prognosis, but
challenges remain associated with late treatment and a complex clinical picture.
Methods
The work included a systematic analysis of scientific publications, clinical protocols and
standards for managing patients with secondary strabismus. Additionally, observations from
the clinical practice of the ophthalmology department were included, covering patients aged
5–60 years with newly diagnosed strabismus.
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The examination of patients included:
• Testing visual acuity and binocular function;
• Application of closure tests and prismatic measurement of the deviation angle;
• Evaluation of eye movements and identification of movement limitations;
• Neuroimaging (MRI, CT) if cranial nerve damage is suspected;
• Consultations with neurologists and related specialists, if necessary.
Discussion
Etiological factors
The key causes of secondary strabismus include:
• Paresis of cranial nerves III, IV, VI, caused by microangiopathy in chronic diseases
(diabetes mellitus, hypertension) or brain injuries;
• Orbital trauma and surgeries affecting the functional activity of the oculomotor muscles;
• Neurological diseases — stroke, multiple sclerosis, CNS tumors that disrupt the motor
pathways of the eyes;
• A sharp decrease in vision in one eye, leading to a violation of sensory synergy;
• Systemic autoimmune and endocrine diseases — myasthenia gravis, Graves' disease with
ophthalmopathy.
Symptoms and diagnostics
Typical complaints of patients — double vision (diplopia), which intensifies with fatigue
and a change in the direction of gaze. Diagnostics is aimed at accurately measuring the angle
of deviation, determining the nature of strabismus (restrictive or paralytic), and excluding
volumetric lesions using neuroimaging.
Treatment
A comprehensive approach includes:
• Optical correction using prismatic glasses for temporary elimination of diplopia;
• Orthoptic therapy, which helps improve muscle coordination and binocular vision;
• Botulinum toxin injections to weaken hyperactive extraocular muscles;
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• Surgical treatment used in persistent forms, including shortening or relaxation of muscles;
• Treatment of the underlying systemic disease, which is necessary for stable remission.
Prognosis
Treatment results depend on the timeliness of diagnosis and adequacy of therapy. Early
intervention allows preserving and restoring binocular vision, preventing the development of
amblyopia in children. In adult patients, combined treatment methods improve quality of life
and reduce symptoms.
Conclusion
Secondary strabismus is a complex condition indicating the presence of systemic or
neurological disorders. Its diagnosis and treatment require a comprehensive and
multidisciplinary approach. The interaction of ophthalmologists, neurologists and other
specialists ensures full therapy and improvement of patients' visual function. Early detection
and timely treatment significantly increase the effectiveness of interventions and the quality
of life of patients, turning secondary strabismus from a symptom into a manageable
condition.
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