Gayle Shimokaji M.D.
Board Certified
Ophthalmologist
1000 South Eliseo Drive, Suite 203
Greenbrae, California 94904
415-925-2020
Dr. Shimokaji attended Moorfields Eye Hospital in London, England as a fellowship in Pediatric and Strabismus. She provides children and adults with medical and surgical care for amblyopia (lazy eye), glasses, contacts and surgical management. She is also certified in Botox for Strabismus which is a great alternative for small misalignments of the eye or for those who do not want surgical adjustments.
OVERVIEW
Strabismus is a disorder in which the eyes do not line up in the same direction when focusing. The condition is more commonly known as "crossed eyes."
SYMPTOMS
Crossed eyes
Double vision
Eyes that do not align in the same direction
Uncoordinated eye movements (eyes do not move together)
Vision loss in one eye, includes a loss of the ability to see in 3-D (loss of depth perception)
TREATMENT
Treatment involves strategies to strengthen the weakened muscles and realign the eyes. Glasses, patching, drops or surgery may be prescribed.
If the condition is caused by a lazy eye, the doctor may prescribe an eye patch for the lazy eye or weaker eye. Some children may need surgery for larger misalignments or symptoms not corrected by glasses. BOTOX injections to correct strabismus is an FDA approved method to correct misalignments and may be permanently corrected. Please make an appointment with Dr. Gayle Shimokaji for further information on various treatment modalities, risks, complications and prognosis. She has over 20 years of experience with pediatric and adults treatments for strabismus and was trained at California Pacific Medical Center in San Francisco and Moorfields Eye Hospital in London, England. Dr. Shimokaji is the consultant at Kentfield Rehabilitation Hospital where she performs all the BOTOX and surgical corrections for stroke and trauma patients with misaligned eyes.
CAUSES
Strabismus is caused by a lack of coordination between the eyes. As a result, the eyes look in different directions and do not focus at the same time on a single point.
In most cases of strabismus in children, the cause is unknown. In more than half of these cases, the problem is present at or shortly after birth (congenital strabismus).
In children, when the two eyes fail to focus on the same image, the brain may learn to ignore the input from one eye. If this is allowed to continue, the eye that the brain ignores will never see well. This loss of vision is called amblyopia, and it is frequently associated with strabismus.
Some other disorders associated with strabismus in children include:
Congenital rubella
Hemangioma near the eye during infancy
Incontinentia pigmenti syndrome
Prader-Willi syndrome
Traumatic brain injury
Trisomy 18 (a child has 3 copies of chromosome 18, instead of the normal 2 copies)
Strabismus that develops in adults can be caused by:
Diabetes (causes a condition known as acquired paralytic strabismus)
Injuries to the eye
Shellfish poisoning
Traumatic brain injury
Vision loss from any eye disease or injury
A family history of strabismus is a risk factor. Farsightedness may be a contributing factor. In addition, any other disease causing vision loss may cause strabismus.
TESTS AND DIAGNOSIS
A physical examination will include a detailed examination of the eyes. Tests will be done to determine the strength of the eye muscles or their misalignment. The examination will take approximately 1 1/2 hours. Your eyes will be dilated which can take 30 minutes of waiting time for the drops to activate and will last 2-6 hours. You need to bring sunglasses with you and any glasses or contacts previously prescribed. Any old medical records are helpful.
EYE TESTS include:
Retinal exam
Comprehensive ophthalmic exam
Visual acuity and assessment for glasses, contacts, patching or drops.
A neurological examination will also be performed.
PROGNOSIS
With early diagnosis and treatment, the problem can usually be corrected. Delayed treatment may lead to permanent vision loss in one eye.
WHEN TO CONTACT THE DOCTOR
Strabismus requires prompt medical evaluation. Call for an appointment with your OPHTHALMOLOGIST if your child:
Appears to be cross-eyed
Complains of double vision
Has difficulty seeing
ALL CHILDREN SHOULD BE EVALUATED BY AN OPHTHALMOLOGIST BEFORE STARTING SCHOOL OR EARLIER TO SCREEN FOR AMBLYOPIA OR LAZY EYE. INFANTS AND NEWBORNS CAN ALSO BE EVALUATED. The earlier the diagnosis, the better the prognosis since the visual system is correctable until ages 7-12.
Note: Learning difficulties or problems at school can sometimes be due to a child's inability to see the blackboard or reading material.
GAYLE SHIMOKAJI M.D.
Medical and Surgical Ophthalmology
Diseases and Surgery of the Eye
1000 S. Eliseo Dr. #203
Greenbrae, Ca. 94904
415-925-2020
fax:415-925-1870
POST OPERATIVE INSTRUCTIONS FOR
STRABISMUS SURGERY
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1. Expect the eye to be red and irritated with occasional
tearing. This should gradually improve over the next several
weeks.
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2. There are no restrictions on diet. The only restrictions on
physical activity are to keep the eyes free of water an dirt
for one week. Sponge bathing or a tub bath
keeping the eye dry is recommended for the first week.
Regular bathing, showering, and swimming are allowed after
one week.
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3. Call Doctor Shimokaji if you have:
Severe and persistent pain
Severe and persistent discharge
Loss of vision
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4. You will be seen in the office on the day following surgery.
Please call the office if you do not have an appointment.
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5. Your postoperative medications are:
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Maxitrol drops: 1 drop in each operated eye, 4 times a day for 14 days. -
Tylenol as needed
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Vicodan 1-2 pills every 4-6 hours as needed for pain.
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Artificial tears, preservative-free (over the counter) drops; 1-2 drops in each eye 4-6 times a day for irritation or dryness (for as long as the irritation lasts).
click below to download strabismus post op sheet
