Strabismus: Insights from a Patient with Cervical Dystonia

Is it strabismus?

Hello doctor, I have a condition known as cervical dystonia, which affects the muscles in my neck, specifically on the right side.
I developed this condition when I was 12 years old; prior to that, everything was normal.
As a result, my neck tilts upward to the right, and I tend to look at things with my eyes angled downward.
During my university years, I noticed that when I tilt my head back to drink water, my right eye appears to diverge outward when looking at the bottom of the cup, while my left eye maintains a normal line of sight when looking at people.
I also observed that when taking photos or looking in the mirror with my head tilted back, my right eye tends to drift outward, and I have to adjust the angle of the mirror or my phone for my eyes to appear aligned.
On April 5, 2023, I asked my niece to check my eyes.
She mentioned that when I looked at her, my right eye seemed slightly crossed, with the left eye almost crossing as well.
However, when I asked her to check again, she said everything looked normal and there was no strabismus.
Recently, I noticed that when I look closely in the mirror, both of my eyes appear to drift outward.
(However, I understand that it is common for eyes to appear this way when looking closely in the mirror.) Because of these symptoms, I visit an ophthalmologist every two years to check for strabismus.
The doctor uses a flashlight to examine my eyes and states that the pupils are centered and there are no issues.
So, what exactly is happening with my eyes?

Enen, 30~39 year old female. Ask Date: 2023/04/07

Dr. Cai Wenyuan reply Ophthalmology

It is recommended to visit a medical center for examination.

Reply Date: 2023/04/07

More Info

Strabismus, commonly known as "crossed eyes" or "squint," is a condition where the eyes do not properly align with each other when looking at an object. This misalignment can occur in various forms, including esotropia (inward turning of one or both eyes), exotropia (outward turning), hypertropia (one eye is higher than the other), and hypotropia (one eye is lower). In your case, it seems that you are experiencing symptoms that may be related to your cervical dystonia, a movement disorder characterized by involuntary muscle contractions that cause abnormal postures, particularly in the neck.

Cervical dystonia can lead to a variety of secondary effects, including strabismus. The abnormal head posture associated with cervical dystonia can affect the positioning of the eyes and the way they work together. When your head tilts or turns, the muscles controlling eye movement may not function optimally, leading to misalignment. This can explain why you notice your right eye drifting outward when you tilt your head back to drink from a cup or when looking in the mirror.

Your experience of having normal eye alignment during routine examinations, despite noticing misalignment in certain positions, is not uncommon. Eye doctors often assess strabismus by observing the alignment of the eyes in various positions and under different conditions. The fact that your doctor did not find any significant issues during these assessments suggests that your strabismus may be functional rather than structural, meaning it could be influenced by your head position and muscle control rather than a permanent misalignment.

The observation of "crossed eyes" or misalignment when looking closely at a mirror or during specific activities could be a result of the way your brain is processing visual information in conjunction with the abnormal neck posture caused by cervical dystonia. This can lead to temporary changes in how your eyes align, especially when you are in a position that is not typical for you.

It is essential to continue monitoring your symptoms and discussing them with your healthcare provider. They may recommend a comprehensive evaluation by both a neurologist and an ophthalmologist to explore the relationship between your cervical dystonia and strabismus further. Treatment options may include physical therapy to address the cervical dystonia, which could help improve head posture and, consequently, eye alignment. In some cases, prism glasses or other visual aids may be suggested to help manage the symptoms of strabismus.

In summary, while your experiences with strabismus may be concerning, they are likely related to the underlying cervical dystonia and the resulting abnormal head posture. Regular follow-ups with your healthcare providers will be crucial in managing both conditions effectively. If you notice any changes in your vision or eye alignment, or if your symptoms worsen, do not hesitate to seek medical advice promptly.

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