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A life-changing opportunity to help a patient with strabismus improve eye alignment

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David strabismus patient

Before and after photo courtesy of David's parents

As an ophthalmologist at Texas Children’s, I provide care to many patients in need of medical or surgical treatment for various pediatric eye disorders including amblyopia (lazy eye), tear duct obstructions and strabismus, the most common eye problem that our team treats in children as young as a year old.

Commonly referred to as crossed eyes or wandering eyes, strabismus occurs when there is an eye muscle imbalance or a signaling issue between the brain and eye. Normally, the muscles attached to the eye work together to move both eyes at the same time. The most noticeable signs of strabismus are eyes that don’t look in the same direction at the same time, eyes that don’t move together, or squinting or closing one eye in bright sunlight. I’ve treated many patients with different types of strabismus, like esotropia (eyes turning inward), exotropia (eyes drifting outward), hypertropia (one eye drifting upward) and hypotropia (one eye drifting downward). If strabismus is diagnosed and treated early, the greater the chances are for the child to develop good depth perception, good vision and straight eyes.

Depending on the severity of the condition, some cases of strabismus can be corrected without surgery. Eyeglasses may be prescribed to align the eyes as much as possible and improve vision. In some cases, a child may need to wear an eye patch over the normally functioning eye for several hours each day to improve strength and vision in the weaker and misaligned eye. The eye patching technique trains the brain to pay attention to both eyes, which may help improve alignment. If these treatments do not work, eye muscle surgery may be recommended to correct strabismus. This was the case for my 2-year-old patient, David, who had shown signs of intermittent exotropia at a very young age.

“When David was 8-months old, we noticed our son’s eyes looked different,” said Michael, David’s dad. “He didn’t have as much control over his eye movements. At the time, we weren’t sure if it was because he was too young or if there was something medically wrong with his eyes. After we consulted with David’s pediatrician, she recommended we take our son to an eye specialist for further evaluation. When we took him there, the doctor told us our son would likely need surgery. Instead of acting on our pediatrician’s first recommendation, we decided to do our due diligence. We began researching different physicians and their backgrounds. During our search, we came across the profile of Dr. Madhuri Chilakapati on Texas Children’s website. After watching her video presentation on strabismus, it was evident to us she had extensive experience performing these delicate surgeries to correct different forms of this condition. We felt she would be the best surgeon to treat our son. We scheduled an appointment to see Dr. Chilakapati.”

When I first met David and his parents a little over a year ago, they were concerned about their child’s exotropia, a form of strabismus in which one or both of the eyes turn outward. I suggested to them that we hold off on surgery since their son was young and his vision and eye muscles were still developing. Instead, I suggested we focus on non-surgical treatments to see if his eyes would correct on their own.

“We tried eye patching for a while, but it was really difficult to keep the patch on him when he got older,” Michael said. “While some children who have strabismus wear eyeglasses, our son didn’t need glasses because his vision wasn’t bad. So, the only real option for us was patching and waiting to see if his eye condition would improve over time. Over the course of a year, my wife and I noticed David’s eyes were turning outward more frequently. If you were one or two feet away from him, it was difficult to notice. As soon as you were six feet away, like sitting across the dinner table from him, his eyes would wander repeatedly. At our son’s follow-up visit with Dr. Chilakapati, we discussed eye surgery as our next option.”

Since the drifting out of the eyes was worsening, I told David’s parents this would be a good idea for us to consider eye surgery, but I wanted them to be comfortable and make this decision on their own. Once they agreed this surgery would be beneficial for David in the long run, my team and I reassured the family on what to expect before, during and after surgery, the risks of the procedure, and we answered any questions or concerns they had. On May 11, 2021, I performed David’s strabismus surgery. This procedure involved readjusting the muscles to reduce the wandering of the eyes. The surgery resulted in a successful outcome.

“After our son’s surgery, the immediate results were unbelievable,” Michael said. “If you look at him today, you’d never know he had strabismus. Since his surgery two months ago, David’s eyes are straight, he has better balance, he’s more confident and he doesn’t squint in the sun anymore. I can’t say enough good things about our experience with Dr. Chilakapati and Texas Children’s. Everyone from the nurses to the physicians and support staff, were compassionate and made sure we were okay. While we were in the waiting room, they gave us updates on how David was doing. We knew when our son was prepping for surgery, when he was going into surgery and when he was in post-recovery. My advice to families facing similar situations is to do your research. We researched everything we needed to know about strabismus, the hospital, and then specifically, the physician who we wanted to entrust our child to for care. In the end, we are grateful to have found Dr. Chilakapati. She changed our son’s life greatly.”

I am so happy David is doing well. When I see positive patient experiences like this, I am reminded why I chose to become a pediatric ophthalmologist. Every day, I am given this incredible opportunity to make a positive difference for my patients and their families. For this reason, I am humbled and grateful.

Strabismus surgery is the most common procedure performed by our pediatric ophthalmologists. We have expert physicians at multiple locations including Texas Children’s Hospital in the Texas Medical Center, Texas Children’s Hospital West Campus, Texas Children’s Hospital The Woodlands, and our specialty care locations in Sugar Land, Cy-Fair and Austin, who see patients with strabismus and perform this procedure. Click here to learn more about our ophthalmology team and services at Texas Children’s.

By: Madhuri Chilakapati, M.D., Pediatric Ophthalmologist

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